Ann Thorac Surg 1998;65:1475-1476
© 1998 The Society of Thoracic Surgeons
How to Do It
Clamp for Coronary Artery Operations
Abhay Singh Walia, MCha,
Shrikant D. Kole, MCha
a Department of Cardiothoracic Surgery, Bombay Hospital Institute of Medical Sciences and Research Centre, Mumbai, India
Accepted for publication November 14, 1997.
Address reprint requests to Dr Kole, S/2, Amrut Siddhi, 24 Ravi Industrial Compound, Near Anjali Society, Thane (W)-400 602, India
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Abstract
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Aortocoronary bypass grafting is an accepted procedure for ischemic heart disease. Proper visualization of the coronary artery is mandatory for good surgical anastomosis. This is essential when a coronary operation is performed without cardioplegia or in surgical procedures without bypass support. For better visualization of a coronary artery, we are presenting a coronary artery clamp. We have used this clamp in minimally invasive coronary artery operations to achieve a bloodless field.
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Introduction
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A bloodless field is a necessity in any coronary artery operation, especially in minimally invasive coronary artery operations. To achieve this, many techniques have been used, such as warm saline irrigation, snare sutures, tourniquets, blockers, silicone rubber loops, and gas jets [1–3]. In spite of these techniques, one assistant may be constantly required to keep the operative field dry with suction [1].
We have devised a clamp for coronary operations (CAS Clamp; Maruti Surgical Works, Mumbai, India) which achieves a good bloodless field.
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Technique
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The CAS Clamp is a modified bulldog clamp of stainless steel. It has two needles, 15 mm in length, fixed to the clamp end in a perpendicular direction (Fig 1). The clamp is small and atraumatic. It can be used in two ways: (1) both needles can be buried vertically into the myocardium by the side of the coronary artery, thus compressing the myocardium to achieve compression of the coronary artery, or (2) the clamp can be positioned in such a manner that one needle lies anterior and the other posterior to the coronary artery in a horizontal plane. This procedure is more effective than the first (Fig 2).
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Fig 2. Clamp in situ. (C = chest spreader; CA = coronary artery; H = clamp in horizontal position; V = clamp in vertical position.)
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The clamp, being small and remaining fixed away from the site of the anastomosis, does not obscure the operative field. There is no entanglement of sutures, minimum instruments in the operative field, and no fear of injury to the coronary artery with this clamp. The needle puncture bleeding stops in a few minutes after removal of the clamp.
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Comment
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We find this clamp to be safe and effective in producing a clean operative field. We avoid endothelial damage caused by blockers [2] and prevent gas embolism as a result of gas jets [2] by using this clamp. For the past year we have been using this clamp for minimally invasive direct coronary artery bypass grafting and also routine coronary artery bypass grafting cases, for nearly all coronary arteries in which there is a retrograde or antegrade bleed. The needle puncture bleeding stops in a few minutes after removal of the clamp. We expect no injury to the coronary artery caused by this clamp as the clamp is applied about 3 to 4 mm away from the artery, which includes a bit of the myocardium. We do not recommend this clamp to be used for calcified vessels because it could cause trauma to the vessel.
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References
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- Acuff T.E., Landreneau R.J., Bartley P.G., Mack M.J. Minimally invasive coronary artery bypass grafting. Ann Thorac Surg 1996;61:135-137.[Abstract]
- Teoh K.H.T., Panos A.L., Harmantas A.A., Lichtenstein S.V., Salerno T.A. Optimal visualization of coronary artery anastomoses by gas jet. Ann Thorac Surg 1991;52:564.[Abstract/Free Full Text]
- Salerno T.A., Christakis G.T., Abel J., et al. Technique and pitfalls of retrograde continuous warm blood cardioplegia. Ann Thorac Surg 1991;51:1023-1025.[Abstract/Free Full Text]
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Abstract
Introduction
