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Off-pump complete revascularization through a left lateral thoracotomy (ThoraCAB): the first 200 cases
Sudhir P Srivastava1, Kirit N Patel, Rajaratnam Skantharaja
1Cardiac Surgical Associates of West Texas, Odessa, Texas 79761, USA. ssrivastava@msn.com
The Annals of Thoracic Surgery
|July 5, 2003
Summary
This study introduces thoracoscopic coronary artery bypass grafting (thoraCAB), a novel technique for complete revascularization without cardiopulmonary bypass. ThoraCAB demonstrates feasibility and safety, offering a potentially less morbid alternative to conventional surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Surgical Innovation
Background:
- Conventional coronary bypass surgery (CABG) involves cardiopulmonary bypass (CPB) and median sternotomy, leading to significant morbidity.
- An innovative technique, thoracoscopic coronary artery bypass grafting (thoraCAB), has been developed to perform complete revascularization via a lateral thoracotomy without CPB.
- This approach aims to reduce the complications associated with traditional CABG.
Purpose of the Study:
- To describe and evaluate the feasibility and outcomes of the thoraCAB technique.
- To assess the safety and efficacy of performing complete coronary revascularization using a minimally invasive, off-pump approach.
- To compare the morbidity profile of thoraCAB with conventional CABG.
Main Methods:
- The thoraCAB procedure involves patient positioning with the left side elevated and a small lateral thoracotomy incision.
- Harvesting of the left internal thoracic artery as a pedicle graft, followed by proximal and distal anastomoses on the beating heart using a stabilizer.
- Intercostal nerve freezing was employed to potentially reduce postoperative pain.
Main Results:
- Complete revascularization was achieved in all 200 patients, with an average of 2.9 grafts per patient.
- The study reported a low mortality rate (0.5%), no strokes, and low rates of prolonged ventilation (1.5%) and reexploration for bleeding (2.5%).
- Postoperative atrial fibrillation occurred in 8% of patients, and intercostal nerve freezing was noted for potential pain reduction.
Conclusions:
- Thoracoscopic coronary artery bypass grafting (thoraCAB) is a feasible technique for the majority of patients requiring coronary bypass surgery.
- The procedure demonstrated a low prevalence of postoperative atrial fibrillation and potential for reduced postoperative pain.
- ThoraCAB represents a promising alternative to conventional CABG, potentially offering reduced morbidity.