HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sudhir P. Srivastava Kirit N. Patel Rajaratnam Skantharaja Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Srivastava, S. P. Articles by Srivastava, V. Search for Related Content PubMed PubMed Citation Articles by Srivastava, S. P. Articles by Srivastava, V. Related Collections Coronary disease

Ann Thorac Surg 2003;76:46-49
© 2003 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Off-pump complete revascularization through a left lateral thoracotomy (ThoraCAB): the first 200 cases

^a Cardiac Surgical Associates of West Texas, Odessa, Texas, USA

^* Address reprint requests to Dr Sudhir P. Srivastava, Cardiac Surgical Associates of West Texas, PA, 419 West 4th, Ste 1000, Odessa, TX79761, USA
e-mail: ssrivastava{at}msn.com

Presented at the Video Session of the Forty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 8–10, 2001.

BACKGROUND: Conventional coronary bypass surgery is associated with substantial morbidity caused by cardiopulmonary bypass (CPB) and median sternotomy. This report describes an innovative technique to perform complete revascularization through a lateral thoracotomy without CPB (thoraCAB).

METHODS: From February 2000 to April 2001 a total of 200 patients underwent thoraCAB. The patient is positioned with the left side elevated to 45 degrees. A 5- to 6-inch incision is made over the left fourth or fifth intercostal space from just medial to the nipple to the anterior axillary line. The left internal thoracic artery is harvested as a pedicle graft under vision. Proximal anastomoses are first completed on the ascending aorta, followed by the distal coronary anastomoses on the beating heart using a stabilizer. Intercostal nerve freezing is done using a cryoprobe.

RESULTS: Complete revascularization was achieved in all patients. The number of grafts averaged 2.9 ± 1.08 per patient. One patient (0.5%) died of renal failure. Two patients (1%) were converted to CPB. No strokes were observed. Three patients (1.5%) required prolonged ventilation (>48 hours). Five patients (2.5%) had postoperative bleeding requiring reexploration. Of the patients, 16 (8%) developed new-onset postoperative atrial fibrillation.

CONCLUSIONS: ThoraCAB has been feasible in the vast majority of patients requiring coronary bypass surgery. The prevalence of postoperative atrial fibrillation was low. Postoperative pain maybe lessened with intercostal nerve freezing.

This article has been cited by other articles:

				T. M. Dewey and M. J. Mack Myocardial Revascularization without Cardiopulmonary Bypass Card. Surg. Adult, January 1, 2008; 3(2008): 633 - 654. [Full Text]

				M. C. Guida, G. Pecora, A. Bacalao, G. Munoz, P. Mendoza, and L. Rodriguez Multivessel Revascularization on the Beating Heart by Anterolateral Left Thoracotomy Ann. Thorac. Surg., June 1, 2006; 81(6): 2142 - 2146. [Abstract] [Full Text] [PDF]

				S. Srivastava, S. Gadasalli, M. Agusala, R. Kolluru, J. Naidu, M. Shroff, R. Barrera, S. Quismundo, and V. Srivastava Use of Bilateral Internal Thoracic Arteries in CABG Through Lateral Thoracotomy With Robotic Assistance in 150 Patients. Ann. Thorac. Surg., March 1, 2006; 81(3): 800 - 806. [Abstract] [Full Text] [PDF]

				C. Weissman Pulmonary Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 185 - 211. [Abstract] [PDF]