[Revascularization of the circumflex coronary artery--a new instrument and a technical method]

Exposure of the coronary arteries for the distal anastomosis of the saphenous vein or the internal mammary artery to the coronary arteries may be accomplished by a number of techniques. Commonly practiced techniques of having an assistant retract the heart over a gauze sponge or with a cotton glove may cause unwanted cardiac trauma or disturb topical cooling of the heart. This paper describes our experience in performing saphenous vein grafts to the circumflex coronary artery system with a new instrument. It is a "net-bandage" which is used usually in orthopedics, and we have named it "CX-net". The CX-net is placed behind the heart and drawn tight to the atrioventricular groove by right lateral retraction and securing the umbilical tapes to hemostasis on the right anterior chest wall. Retraction of the CX-net to the right and securing it to the right anterior chest wall tips up the cardiac apex to exposure the posterior surface of the left ventricle for access to the left circumflex coronary artery. By adopting this new instrument and technical method, revascularization of the circumflex coronary artery is performed safely and successfully.