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Eur J Cardiothorac Surg 2001;20:894
© 2001 Elsevier Science NL

Letter to the Editor

Single vessel revascularization with beating heart techniques – minithoracotomy or sternotomy

Zile Singh Meharwal, Naresh Trehan

Department of Cardiovascular Surgery, Escorts Heart Institute And Research Centre, New Delhi, India

Received 9 May 2001; accepted 19 June 2001.

Corresponding author. Tel.: +91-11-6825000; fax no.: +91-11-6825013
e-mail: meharwal{at}hotmail.com

Key Words: Minothoracotomy • Ministernotomy • Beating heart

We read with great interest the article by Detter et al. entitled ‘Single vessel revascularization with beating heart techniques – minithoracotomy or sternotomy’ [1]. The authors have beautifully analysed their results of minithoracotomy and sternotomy. We agree with authors that sternotomy is relatively safer and easier approach as compared to minithoracotomy, though both techniques can achieve good early and midterm results.

Minimally invasive direct coronary artery bypass (MIDCAB) through a small left anterior thoracotomy probably is the commonest approach for LITA-LAD anastomosis and has been associated with good results [2]. We started this approach for single vessel LAD revascularisation in March 1994 and continued till 1998 when we also started using lower partial sternotomy for LIMA-LAD anastomosis. Results of LIMA-LAD anastomosis comparing minithoracotomy and lower partial sternotomy (ministernotomy) were reported from our institute [3]. Between October 1998 and December 1999, 269 patients each were operated using two techniques. Patients in ministernotomy group had less pain than minithoracotomy group from postoperative day 2 onwards. Requirement of pain medication was significantly less in ministernotomy group. Length of harvested IMA was significantly more in ministernotomy group and free flow of IMA also was more in ministrenotomy group. Patency of IMA at mean interval of 10±1.5 months was comparable in two groups.

In our opinion, ministernotomy is superior to full sternotomy for single vessel revascularisation. This technique has the advantage of smaller incision which is cosmetically better and it maintains the sternal stability because sternotomy is required only upto 4th intercostal space. The whole length of the IMA can be harvested under direct vision with the help of the long-tip electrocautry. The ministernotomy can be easily and quickly converted to full sternotomy, if required. Using this technique multiple coronary bypass grafts can also be performed [4].

References

  1. Detter C., Reichenspurner H., Boehm D.H., Thalhammer M., Schutz A., Reichart B. Single vessel revascularization with beating heart techniques – minithoracotomy or sternotomy?. Eur J Cardio-thorac Surg 2001;19:464-470.[Abstract/Free Full Text]
  2. Calafiore A.M., Di Giammarco G., Teodori G., Gallina S., Maddestra N., Paloscia L., Scipioni G., Iovino T., Marco Contini M., Vitolla G. Midterm results after minimally invasive coronary surgery (LAST operation). J Thorac Cardiovasc Surg 1998;115:763-771.[Abstract/Free Full Text]
  3. Trehan N., Malhotra R., Mishra Y., Shrivastava S., Kohli V., Mehta Y. Comparison of ministernotomy with minithoracotomy regarding postoperative pain and internal mammary artery characteristics. Heart Surg Forum 2000;3(4):300-306.[Medline]
  4. Hiroshi N., Takeuchi Y., Suda Y., Ross D.E. Lower sternal splitting approach for off-pump coronary artery bypass grafting. Ann Thorac Surg 2000;70:1431-1433.[Abstract/Free Full Text]




This Article
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Right arrow Minimally invasive surgery

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