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Published on: May 4, 2015
Myocardial revascularization through a mini-thoracotomy with thoracoscopic assistance
G L Martinelli1, M Cassese, G Speziali
1Division of Cardiovascular Surgery, Clinica Villa Maria Pia, Turin, Italy. jerichostar@,iname.com
Summary
Video-assisted thoracoscopy enhances left internal mammary artery harvesting during minimally invasive cardiac surgery. This technique improves vessel mobilization and length, reducing chest trauma and complications for patients undergoing myocardial revascularization.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Thoracic Surgery
Background:
- Harvesting the left internal mammary artery (LIMA) via mini-thoracotomy presents challenges in accessing the proximal vessel.
- This approach risks chest wall trauma due to rib spreading.
Purpose of the Study:
- To evaluate the advantages of video thoracoscopic assistance in LIMA harvesting.
- To assess the feasibility and outcomes of LIMA grafting using a combined surgical and thoracoscopic technique.
Main Methods:
- A 8-12 cm anterior thoracotomy was performed in the left fourth or fifth intercostal space.
- Two thoracoscopic ports were inserted for visualization and instrument manipulation.
- A mixed surgical and thoracoscopic technique was employed for complete LIMA mobilization.
Main Results:
- 12 patients underwent myocardial revascularization with video-assisted LIMA harvesting.
- No deaths or perioperative infarctions were reported.
- Postoperative angiography confirmed adequate LIMA pedicle length in 9 patients, with good graft results in most cases.
Conclusions:
- Thoracoscopic assistance facilitates complete LIMA mobilization.
- This technique maximizes the useful length of the LIMA without requiring an extended thoracotomy.
- Video-assisted LIMA harvesting offers a safe and effective approach for myocardial revascularization.
