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Bilateral thoracoscopic minimally invasive direct coronary artery bypass grafting using internal thoracic arteries
G Watanabe1, T Misaki, K Kotoh
1Department of Surgery (1), Toyama Medical and Pharmaceutical University, Sugitani, Japan.
Insights
Minimally invasive direct coronary artery bypass grafting using bilateral thoracoscopic internal mammary artery harvesting offers a less invasive surgical option for multivessel coronary artery disease, achieving excellent graft patency.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Surgery
- Surgical Innovation
Background:
- Minimally invasive single-vessel coronary artery bypass grafting using the left internal mammary artery (ITA) to the left anterior descending artery yields excellent outcomes.
- This approach is unsuitable for patients with multivessel coronary artery disease.
Purpose of the Study:
- To develop a minimally invasive direct coronary artery bypass grafting procedure for multivessel disease.
- To perform bypass grafting without cardiopulmonary bypass.
Main Methods:
- Thoracoscopic harvesting of both internal mammary arteries (ITAs).
- Bilateral anterior thoracotomies to access the right coronary artery and left anterior descending coronary artery.
- Coronary artery bypass grafting performed off-pump using ITA grafts.
Main Results:
- Successful implementation in 3 patients.
- Patients were extubated in the operating room.
- Postoperative angiography confirmed patent left and right ITA grafts.
Conclusions:
- Bilateral thoracoscopic minimally invasive direct coronary artery bypass grafting is feasible for treating multivessel coronary artery disease.
- Bilateral thoracoscopic ITA harvesting represents a less invasive technique for managing multivessel coronary artery disease.
Background:
Single-vessel coronary artery bypass grafting of the left internal mammary artery (ITA) to the left anterior descending coronary artery using a minithoracotomy has been shown to produce excellent results with a very low mortality. However, this procedure cannot be used in patients with double- or triple-vessel disease. Our goal was to develop a minimally invasive direct coronary artery bypass grafting procedure without cardiopulmonary bypass for patients with multivessel disease.
Methods:
Both ITAs were thoracoscopically harvested using video imaging. Limited bilateral anterior thoracotomies were performed in the fourth intercostal spaces, thus exposing the right coronary artery and the left anterior descending coronary artery. The right ITA-right coronary artery and ITA-left anterior descending coronary artery anastomoses were performed without cardiopulmonary bypass using 8-0 polypropylene sutures.
Results:
This procedure was successfully performed in 3 patients. The patients were extubated in the operating room. Postoperative angiographic studies showed patent left ITA and right ITA grafts.
Conclusions:
Bilateral thoracoscopic minimally invasive direct coronary artery bypass grafting can be used to treat patients with a proximally diseased left anterior descending coronary artery and right coronary artery. Bilateral thoracoscopic ITA harvesting is a less invasive surgical technique that may become an option for the management of multivessel coronary artery disease.