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Ann Thorac Surg 2004;78:1441-1445
© 2004 The Society of Thoracic Surgeons

New technology

Multivessel, All-Arterial, Off-Pump Surgical Revascularization Without Disruption of the Thoracic Skeleton

Thomas A. Vassiliades, Jr, MDa,*

a Pensacola Heart Institute, Pensacola, Florida, USA

Accepted for publication August 28, 2003.

* Address reprint requests to Dr Vassiliades, Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365A Clifton Rd, NE, Atlanta, GA 30322, USA
thomas_vassiliades{at}emoryhealthcare.org

Abstract

PURPOSE: To evaluate the feasibility of performing multivessel off-pump surgical revascularization without manipulation of the thoracic cage.

DESCRIPTION: The technique consists of bilateral thoracoscopic internal mammary artery harvesting followed by a nonrib-spreading, muscle-sparing opening in the soft tissue of the thorax. An endoscopic cardiac positioner and stabilizers exposes and steadies the target arteries beneath a small opening. Anastomoses are constructed off-pump through the natural width of the intercostal space without the need for rib spreading.

EVALUATION: Fifty-two patients underwent all-arterial, off-pump revascularization through incisions avoiding manipulation of the thoracic skeleton. The mean number of grafts per patient was 2.2 ± 0.4. Transit time flow measurements verified graft patency before closure in all cases. The mean operating time was 4.4 hours (range, 3.4 to 5.6). Hospital length of stay was 2.6 ± 1.9 days. There was no early or late mortality. Postoperative angiography performed in 63.8% of the grafts (74 of 116) revealed an overall patency rate of 98.6%.

CONCLUSIONS: A grafting approach that avoids any manipulation of the thoracic skeleton offers significant patient value and may not be limited to single-graft cases.


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INVITED COMMENTARY
Antonio M. Calafiore
Ann. Thorac. Surg. 2004 78: 1445. [Extract] [Full Text] [PDF]



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