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Ann Thorac Surg 1997;64:64-69
© 1997 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Development of a Minimally Invasive Technique for Coronary Revascularization in a Porcine Model

M. Clive Robinson, MD, David R. Gross, DVM, PhD, Kenneth A. Thielmeier, MD, Bradley B. Hill, MD, William F. Zeman, MD

Division of Cardiovascular and Thoracic Surgery and Department of Anesthesiology, College of Medicine, University of Kentucky, Lexington, Kentucky

Accepted for publication January 6, 1997.

Background. This porcine model was designed to develop a minimally invasive method for internal mammary artery (IMA) grafting using an anterior mediastinal approach and without routine use of cardiopulmonary bypass.

Methods. Assessment was made of IMA mobilization through a small parasternal incision, the feasibility of coronary artery grafting with cardiopulmonary bypass using this approach, and conditions for off-pump bypass grafting.

Results. In group 1, 6 pigs underwent IMA mobilization through a 5-cm horizontal midparasternal incision. Of the 2 group 2 pigs, 1 underwent IMA grafting to the left anterior descending coronary artery and the other, bilateral IMA grafting to the left anterior descending and right coronary arteries using femoral-vessel cardiopulmonary bypass. In group 3, 4 of 10 pigs had successful off-pump grafting during retrograde regional coronary venous perfusion of arterial blood. Retrograde coronary venous perfusion could not be established in the other 6 pigs, and attempts at off-pump grafting failed.

Conclusions. The study demonstrates that coronary artery grafting with the IMA by this minimally invasive off-pump method is feasible, although it draws attention to areas of concern and potential methods of correction. The model provides a realistic and important learning platform for the surgical issues involved with this minimally invasive technique.




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