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The "H" graft: an alternative approach for performing minimally invasive direct coronary artery bypass
W E Cohn1, H C Suen, R M Weintraub
1Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. 02215, USA.
Insights
The novel "H" graft minimally invasive direct coronary artery bypass (MIDCAB) offers a simpler, less painful arterial revascularization alternative. This technique avoids chest wall retraction and demonstrates excellent graft patency.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Vascular Grafting
Background:
- Minimally invasive direct coronary artery bypass (MIDCAB) allows arterial revascularization without cardiopulmonary bypass, potentially reducing morbidity.
- However, MIDCAB can be technically demanding and cause significant postoperative pain due to chest wall retraction.
Purpose of the Study:
- To introduce and evaluate the "H" graft technique for MIDCAB.
- To assess the feasibility, safety, and efficacy of this novel approach for left anterior descending artery grafting.
Main Methods:
- Eight patients underwent "H" graft MIDCAB between December 1996 and April 1997.
- The "H" graft involved using a segment of right inferior epigastric artery attached to an in situ left internal thoracic artery for left anterior descending coronary artery grafting.
- This procedure was performed without cardiopulmonary bypass and avoided rib spreading or chest wall retraction.
Main Results:
- No intraoperative conversions to conventional bypass were necessary.
- There were no postoperative deaths or myocardial infarctions.
- Angiography in six patients showed excellent graft patency with rapid filling of the left anterior descending coronary artery.
- All patients experienced resolution of ischemic symptoms or achieved normal exercise tolerance.
- The median postoperative length of stay was 3 days.
Conclusions:
- The "H" graft MIDCAB procedure is a technically simpler and effective alternative to standard MIDCAB.
- It avoids the need for internal thoracic artery harvest and extensive chest wall retraction.
- The technique provides excellent visualization and is associated with favorable early outcomes.
Objectives:
Minimally invasive direct coronary artery bypass permits arterial revascularization without cardiopulmonary bypass, potentially decreasing associated morbidity. The procedure is, however, technically challenging and associated with significant postoperative pain resulting from retraction through the small incision. METHODS AND PATIENT SELECTION: From December 1996 to April 1997, eight patients underwent grafting of the left anterior descending coronary artery by use of a short segment of right inferior epigastric artery attached proximally to the side of an in situ left internal thoracic artery. We have termed this procedure the "H" graft MIDCAB.
Results:
No patients required intraoperative conversion to conventional bypass. No postoperative deaths or myocardial infarctions occurred. Six patients with normal renal function underwent postoperative angiography that demonstrated graft patency with rapid filling of the left anterior descending coronary in each case. Postoperatively clinical signs of acute ischemia were resolved or a normal exercise tolerance test was obtained in all patients. The median postoperative length of stay was 3 days. Rib spreading and chest wall retraction were not required in any procedure.
Conclusions:
The "H" graft procedure is an attractive alternative to standard minimally invasive bypass because of greater technical simplicity, the avoidance of internal thoracic artery harvest, and excellent visualization with no chest wall retraction.