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Published on: November 24, 2014
[Minimally Invasive Coronary Artery Bypass Grafting Using Proximal Anastomoses Device;Report of a Case]
Akihiko Yamauchi1, Masaki Tabuchi, Daisuke Toritsuka
1Division of Cardiovascular Surgery, Tomishiro Central Hospital, Tomishiro, Japan.
Insights
Minimally invasive coronary artery bypass grafting (MICS CABG) using the Heartstring III Proximal Seal System is feasible for treating complex coronary artery disease. This approach demonstrated successful graft patency and a shorter hospital stay.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Vascular Anastomosis Techniques
Background:
- A 68-year-old male with diabetes mellitus and three-vessel coronary artery disease was evaluated for coronary artery bypass grafting (CABG).
- Minimally invasive coronary artery grafting (MICS CABG) was chosen for its potential for faster postoperative recovery compared to traditional off-pump CABG.
- The surgical approach involved a 10 cm left 5th thoracotomy.
Observation:
- In situ bilateral internal thoracic artery (BITA) and saphenous vein graft (SVG) were harvested using specialized instruments.
- The bypass graft configuration included in situ right internal thoracic artery to the left anterior descending artery, in situ left internal thoracic artery to the left circumflex artery, and aorta-to-SVG for the posterior descending artery.
- The Heartstring III Proximal Seal System was employed for the anastomosis of the SVG to the ascending aorta under an off-pump technique.
Findings:
- The MICS CABG procedure was successfully completed without major postoperative complications.
- Postoperative coronary angiography confirmed the patency of all bypass grafts.
- The patient experienced a postoperative hospital stay of 14 days.
Implications:
- This case represents the initial application of the Heartstring III Proximal Seal System in MICS CABG within the institution.
- The findings suggest the realistic possibility and quality of using the Heartstring III Proximal Seal System in MICS CABG procedures.
- Further research is warranted to validate these preliminary results and explore broader applications.
Abstract:
A 68-years-old male with diabetes mellitius (HbA1c 6.5%) was referred for coronary artery bypass grafting(CABG). Preoperative coronary angiography (CAG) signed 3-vessels coronary disease[#2 75 %,#4 posterior descending (PD) 75%,#6 90%,#14 90%]. Minimally invasive coronary artery grafting (MICS CABG) was selected because of faster postoperative recovery than off-pump CABG via a 10 cm left 5th thoracotomy approach. In situ bilateral internal thoracic artery(BITA) and saphenous vein (SVG) was harvested by special manner using long type Harmonic. Bypass graft design was in situ right internal thoracic artery-LAD, in situ left internal thoracic artery-left circumtlex#14, and aorta-SVG-#4PD-#4atrio-ventricular. BITA, the ascending aorta for proximal anastomoses, and all coronary targets were directly accessed with off-pump technique. Heartstring III Proximal Seal System was used to anastomose SVG to the ascending aorta. There were no major postoperative complications. Postoperative CAG revealed all grafts patent and postoperative hospital stay was 14 days. This case was the 1st usage of Heartstring III Proximal Seal System in our clinic. We believe that the usage of Heartstring III Proximal Seal System in MICS CABG is realistically possible, and providing good quality;however, further research will be needed.
