| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
European Journal of Cardio-Thoracic Surgery, Vol 11, 1081-1085, Copyright © 1997 by European Association for Cardio-thoracic Surgery
F Alessandrini, N Luciani, C Marchetti, M Guadino and G Possati
OBJECTIVE: We report the early results of the left anterior descending
artery revascularization through a minimally invasive thoracotomy,
examining the main technical aspects of the operation. METHODS: From
January 1995 to September 1996, 51 patients underwent myocardial
revascularization through a mini-thoracotomy on beating heart without
cardiopulmonary bypass. The main indication to operation was limited
lesions of the left anterior descending artery with contra-indications or
high risk of failure of angioplasty. The position of the patient was the
same than traditional surgery; the chest was opened on the fourth left
intercostal space; the left internal mammary artery harvested under direct
vision; temporary occlusion of the left anterior descending was obtained
prevalently using 5-0 poliypropilene sutures; the anastomosis was performed
with single or double 7-0 or 8-0 suture. In six patients the chest was
closed and a conventional open-heart operation was performed due to
internal mammary artery or left anterior descending unsuitability for
minimally invasive revascularization. All the patients were submitted after
operation to early angiographic control and/or a Doppler study of the
mammary flow. RESULTS: There was no intra-operative mortality. One patient
had a postoperative myocardial infarction of the anterior-lateral wall of
the left ventricle, and died after an emergency open-heart operation. In
one case the patient was reopened after a few hours for a bleeding. Three
patients showed various degrees of anastomotic stenosis at the angiographic
control. CONCLUSIONS: Several technical difficulties can play an important
role in the operative outcome because a single repeated technical error
could not fully explain these heterogeneous observed failures. The
technique of myocardial revascularization through a left anterior small
thoracotomy might present several critical points, particularly: (1) the
harvesting of LIMA, meaning the preservation of integrity of the arterial
wall and adequacy of the length; (2) the method of the temporary closure of
the LAD during of the anastomosis; (3) the stabilization of the LAD and the
surgical technique of the anastomosis; (4) the methods for intraoperative
control of the patency of the anastomosis. All points mentioned have been
thought in our experience to be causes of early failure.
ARTICLES
Early results with the minimally invasive thoracotomy for myocardial revascularization
Department of Cardiac Surgery, A. Gemelli University Hospital, Catholic University, Rome, Italy.
This article has been cited by other articles:
|
|
 |
|
  R. D. L. Stanbridge and L. K. Hadjinikolaou Technical adjuncts in beating heart surgery Comparison of MIDCAB to off-pump sternotomy: a meta-analysis Eur. J. Cardiothorac. Surg., November 1, 1999; 16(suppl_2): S24 - S33. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. I. Bonchek and D. J. Ullyot Minimally Invasive Coronary Bypass : A Dissenting Opinion Circulation, August 11, 1998; 98(6): 495 - 497. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Possati, M. Gaudino, F. Alessandrini, M. Zimarino, F. Glieca, and N. Luciani Systematic clinical and angiographic follow-up of patients undergoing minimally invasive coronary artery bypass J. Thorac. Cardiovasc. Surg., April 1, 1998; 115(4): 785 - 790. [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 |
