A new no-touch aorta technique for arterial-source, off-pump coronary surgery

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Neurological Protection in Cardiac Procedures

Background:

• Off-pump coronary revascularization (OPCAB) aims to reduce invasiveness and improve outcomes.
• Ascending aorta manipulation during OPCAB can be associated with neurological complications.
• Minimizing aortic manipulation is crucial for neuroprotection in cardiac surgery.

Purpose of the Study:

• To present a novel surgical strategy for OPCAB that completely avoids ascending aorta manipulation.
• To describe a technique utilizing the right internal thoracic artery as an arterial inflow source for a saphenous vein graft.
• To evaluate the feasibility and potential benefits of this aorta-avoiding approach.

Main Methods:

• A new surgical plan was devised for coronary artery bypass grafting.
• The proximal stump of the right internal thoracic artery was used as an intrathoracic arterial inflow source.
• A saphenous vein graft was connected to this arterial source, bypassing the need for aortic cannulation.
• This technique allows for grafts of variable length and facilitates a proximal anastomosis with improved conduit matching and lower peak pressure.

Main Results:

• The proposed method successfully avoids direct manipulation of the ascending aorta.
• The use of the right internal thoracic artery provides a suitable arterial source for the saphenous vein graft.
• The proximal anastomosis offers advantages in conduit matching and pressure handling.
• This technique contributes to reducing the overall invasiveness of off-pump coronary revascularization.

Conclusions:

• This innovative surgical approach offers a viable alternative for off-pump coronary revascularization, enhancing neuroprotection by eliminating aortic manipulation.
• The technique is technically feasible and may lead to improved graft patency and reduced perioperative neurological events.
• Further studies are warranted to confirm the long-term benefits and widespread applicability of this aorta-avoiding strategy.