Single and multivessel port-access coronary artery bypass grafting with cardioplegic arrest: Technique and reproducibility Daniel S. Schwartz, MD, Greg.

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Presentation transcript:

Single and multivessel port-access coronary artery bypass grafting with cardioplegic arrest: Technique and reproducibility Daniel S. Schwartz, MD, Greg H. Ribakove, MD, Eugene A. Grossi, MD, Jess D. Schwartz, MD, Patricia M. Buttenheim, MA, F.Gregory Baumann, PhD, Stephen B. Colvin, MD, Aubrey C. Galloway, MD The Journal of Thoracic and Cardiovascular Surgery Volume 114, Issue 1, Pages 46-52 (July 1997) DOI: 10.1016/S0022-5223(97)70116-8 Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A, A thoracoscopic cautery was used to dissect the left and right ITAs from the left-sided chest ports. Downward gentle traction was applied with a thoracoscopic grasper. The ITA (arrow) was dissected from the most proximal to distal extent beyond the bifurcation of the vessel. B, The distal end of the ITA pedicle was brought through the lateral chest port for preparation of the ITA for distal anastomosis to its respective coronary arteries. LIMA, Left ITA. C, A longitudinal opening was made in the pericardium with dissecting thoracoscopic scissors and a thoracoscopic grasper. The arrow points to the medial edge of the pericardium. D, A 20 mm thoracic oval port was inserted through an intercostal space in the anterior chest wall over the LAD artery (arrow), and the distal anastomosis was performed under direct vision with operative loupes. TC, Thoracoscopic cautery; TG, thoracoscopic grasper; TS, thoracoscopic scissors. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 46-52DOI: (10.1016/S0022-5223(97)70116-8) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A, A thoracoscopic cautery was used to dissect the left and right ITAs from the left-sided chest ports. Downward gentle traction was applied with a thoracoscopic grasper. The ITA (arrow) was dissected from the most proximal to distal extent beyond the bifurcation of the vessel. B, The distal end of the ITA pedicle was brought through the lateral chest port for preparation of the ITA for distal anastomosis to its respective coronary arteries. LIMA, Left ITA. C, A longitudinal opening was made in the pericardium with dissecting thoracoscopic scissors and a thoracoscopic grasper. The arrow points to the medial edge of the pericardium. D, A 20 mm thoracic oval port was inserted through an intercostal space in the anterior chest wall over the LAD artery (arrow), and the distal anastomosis was performed under direct vision with operative loupes. TC, Thoracoscopic cautery; TG, thoracoscopic grasper; TS, thoracoscopic scissors. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 46-52DOI: (10.1016/S0022-5223(97)70116-8) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A, A thoracoscopic cautery was used to dissect the left and right ITAs from the left-sided chest ports. Downward gentle traction was applied with a thoracoscopic grasper. The ITA (arrow) was dissected from the most proximal to distal extent beyond the bifurcation of the vessel. B, The distal end of the ITA pedicle was brought through the lateral chest port for preparation of the ITA for distal anastomosis to its respective coronary arteries. LIMA, Left ITA. C, A longitudinal opening was made in the pericardium with dissecting thoracoscopic scissors and a thoracoscopic grasper. The arrow points to the medial edge of the pericardium. D, A 20 mm thoracic oval port was inserted through an intercostal space in the anterior chest wall over the LAD artery (arrow), and the distal anastomosis was performed under direct vision with operative loupes. TC, Thoracoscopic cautery; TG, thoracoscopic grasper; TS, thoracoscopic scissors. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 46-52DOI: (10.1016/S0022-5223(97)70116-8) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A, A thoracoscopic cautery was used to dissect the left and right ITAs from the left-sided chest ports. Downward gentle traction was applied with a thoracoscopic grasper. The ITA (arrow) was dissected from the most proximal to distal extent beyond the bifurcation of the vessel. B, The distal end of the ITA pedicle was brought through the lateral chest port for preparation of the ITA for distal anastomosis to its respective coronary arteries. LIMA, Left ITA. C, A longitudinal opening was made in the pericardium with dissecting thoracoscopic scissors and a thoracoscopic grasper. The arrow points to the medial edge of the pericardium. D, A 20 mm thoracic oval port was inserted through an intercostal space in the anterior chest wall over the LAD artery (arrow), and the distal anastomosis was performed under direct vision with operative loupes. TC, Thoracoscopic cautery; TG, thoracoscopic grasper; TS, thoracoscopic scissors. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 46-52DOI: (10.1016/S0022-5223(97)70116-8) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 A, Still frame from an angiogram demonstrating proper position of the endovascular aortic clamp (EAC) balloon (arrow) in the ascending aorta (AO) with complete occlusion. Note the antegrade filling of the LAD artery and the cusps of the aortic valve. B, Still frame from an angiogram confirming the endovascular aortic clamp position in relationship to the aortic (AO) great arch vessels (GV). The venous drainage catheter (VC) is visualized inferiorly. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 46-52DOI: (10.1016/S0022-5223(97)70116-8) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 A, Still frame from an angiogram demonstrating proper position of the endovascular aortic clamp (EAC) balloon (arrow) in the ascending aorta (AO) with complete occlusion. Note the antegrade filling of the LAD artery and the cusps of the aortic valve. B, Still frame from an angiogram confirming the endovascular aortic clamp position in relationship to the aortic (AO) great arch vessels (GV). The venous drainage catheter (VC) is visualized inferiorly. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 46-52DOI: (10.1016/S0022-5223(97)70116-8) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 Still frame from an angiogram obtained after the procedure, demonstrating patency of the left ITA (LIMA) to the LAD artery. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 46-52DOI: (10.1016/S0022-5223(97)70116-8) Copyright © 1997 Mosby, Inc. Terms and Conditions