Off-pump awake coronary revascularization using bilateral internal thoracic arteries

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Anesthesiology

Background:

• A novel technique for complete arterial revascularization of the heart's lateral/inferior walls has been developed.
• This method utilizes in situ bilateral internal thoracic artery grafts in awake patients.
• It offers the least invasive revascularization for the lateral/posterior heart walls, avoiding cardiopulmonary bypass and mechanical ventilation.

Purpose of the Study:

• To evaluate the feasibility and safety of complete arterial revascularization using bilateral internal thoracic artery grafts in awake patients.
• To assess the efficacy of off-pump coronary artery bypass grafting without general anesthesia for multivessel disease.

Main Methods:

• Seven patients underwent double or triple vessel coronary artery bypass grafting without general anesthesia, utilizing high thoracic epidural anesthesia.
• Bilateral internal thoracic arteries were harvested for off-pump anastomoses via median sternotomy.
• Coronary arteries (circumflex or right coronary artery) were anastomosed with bilateral internal thoracic arteries using a heart positioner.

Main Results:

• All patients remained awake throughout the procedure with no perioperative myocardial infarction or mortality.
• Three patients experienced pneumothorax, with two requiring repair; one patient had unilateral pneumothorax.
• No hemodynamic or pulmonary complications occurred during revascularization; two patients needed unexpected coronary endarterectomy.

Conclusions:

• Complete arterial revascularization via median sternotomy using in situ bilateral internal thoracic artery grafts without general anesthesia is feasible and safe for multivessel disease.
• This approach enables awake revascularization of the right and/or circumflex coronary arteries.
• The technique represents a significant advancement in minimally invasive cardiac surgery.