ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

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

Ann Thorac Surg 2006;81:800-806
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Use of Bilateral Internal Thoracic Arteries in CABG Through Lateral Thoracotomy With Robotic Assistance in 150 Patients

Sudhir Srivastava, MD d , * , Suresh Gadasalli, MD b , Madhava Agusala, MD b , Ram Kolluru, MD b , Jayaram Naidu, MD b , Manish Shroff, MD c , Reyna Barrera, PAC d , Shaune Quismundo, RN d , Vishwa Srivastava, BA a , d

a Department of Cardiovascular Surgery, Odessa, Texas
b Department of Cardiology, Odessa, Texas
c Alliance Hospital, Odessa, Texas
d Cardiac Surgical Associates, Odessa, Texas

Accepted for publication August 22, 2005.

* Address correspondence to Dr Sudhir Srivastava, 710 East 6th St, Odessa, TX 79761 (Email: sudhirpsrivastava{at}mac.com).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: Internal thoracic arteries (ITA) have been shown to offer longer graft patency. Off-pump coronary artery bypass graft surgery (CABG) through small lateral thoracotomy has been reported. The present study deals with feasibility of using bilateral ITAs (BITA) in CABG through small lateral thoracotomy facilitated by the da Vinci robotic system.

METHODS: Since July 2002, 150 patients underwent CABG through small lateral thoracotomy using robotic assistance for harvesting of BITA. After single lung ventilation, three 1- to 2-cm incisions were made in the third, fifth, and seventh intercostal spaces 2 to 3 cm medial to the anterior axillary line. After insertion of camera and instrument arms, both ITAs were harvested in a completely skeletonized fashion. A small anterolateral thoracotomy was done, enlarging the camera port incision. Distal anastomoses were performed on a beating heart using nitinol surgical clips. Intercostal cryoanalgesia and local anesthetic infusion were used for pain management.

RESULTS: Planned arterial revascularization was completed in 148 patients. Mean number of arterial grafts per patient was 2.6 ± 0.8. All coronary arteries could be reached with BITA as in situ or composite grafts. There was no mortality, stroke, myocardial infarction, or wound infection. Seven patients had new onset atrial fibrillation. Four patients required exploration of postoperative bleeding. Mean postoperative length of stay was 3.6 ± 2.9 days.

CONCLUSIONS: The da Vinci robotic system was found to be safe and feasible for BITA harvesting in multivessel CABG through small lateral thoracotomy. Further follow-up for graft patency is necessary. Postoperative pain may be reduced with aggressive management strategies. The approach offers fast recovery. This sternum-sparing approach may be an evolutionary step toward closed-chest coronary artery bypass graft surgery.




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
F. Robicsek
Robotic cardiac surgery: time told!
J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 243 - 246.
[Full Text] [PDF]

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

Home page
 Card Surg AdultHome page
V. Falk and F. W. Mohr
Minimally Invasive Myocardial Revascularization
Card. Surg. Adult, January 1, 2008; 3(2008): 697 - 710.
[Full Text]

Home page
 ChestHome page
S. R. Bapoje, J. F. Whitaker, T. Schulz, E. S. Chu, and R. K. Albert
Preoperative Evaluation of the Patient With Pulmonary Disease
Chest, November 1, 2007; 132(5): 1637 - 1645.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The Society of Thoracic Surgeons.