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Subxiphoid multi-arterial OPCAB: surgical technique and initial case report.

Mark M Levinson1

  • 1Cardiothoracic Surgery, Hutchinson Hospital, Hutchinson, KS 67502, USA. mmlevinson@hsforum.com

The Heart Surgery Forum
|August 23, 2005
PubMed
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This study introduces a novel subxiphoid approach for multivessel coronary artery bypass grafting (CABG) on a beating heart. This minimally invasive technique offers a promising alternative to traditional sternotomy for complex cardiac surgeries.

Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Cardiac Surgery
  • Surgical Innovation

Background:

  • Traditional transsternal coronary artery bypass grafting (CABG) has seen limited innovation.
  • Existing minimally invasive techniques like minithoracotomy and totally endoscopic CABG have limitations for multivessel grafting.
  • A need exists for a less invasive multivessel CABG approach with a manageable learning curve and acceptable costs.

Observation:

  • A novel subxiphoid surgical technique was developed for multi-arterial bypass grafting.
  • The technique involves xiphoid process removal, sternal lifting, diaphragm retraction, and specialized retraction for cardiac access.
  • Full-length skeletonized internal mammary arteries were used as conduits for off-pump distal anastomoses.

Findings:

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  • Successful multivessel coronary artery bypass grafting was performed via a small subxiphoid incision.
  • Distal anastomoses were achieved on the beating heart, including to the lateral wall (obtuse marginal branch).
  • The patient, a 79-year-old male, experienced no complications and was discharged on postoperative day 4 with complete angina relief.

    • Implications:

    • The subxiphoid approach allows for multivessel grafting to all heart regions using existing surgical skills.
    • This technique has the potential to reduce invasiveness and hospital costs for CABG.
    • Further development may enable outpatient CABG with superior long-term outcomes compared to coronary stenting.