oa Cardiovascular Journal of Africa - Our experience with minimally invasive coronary artery bypass grafting and thoracoscopic internal mammary artery harvest with the Harmonic scalpel
Background. Minimally invasive coronary artery bypass graft (MICABG) techniques are evolving. Thoracoscopic internal mammary artery (IMA) harvest is a demanding procedure. Our experiences with MICABG and a new IMA harvest technique (Wolf technique) are descriptionbed here. Materials and methods. Since October 1995, MICABG was applicable in 51 patients with a mean age of 70.2 ï¿½ 12.5 years, using 40 IMAs (29 left and 11 right), 7 gastroepiploic arteries, 4 saphenous vein grafts and 1 radial artery graft. Thirteen (25%) of the 51 patients were undergoing repeat surgery. A total of 27 IMAs (22 left and 5 right) were harvested with the Harmonic scalpel (Ethicon Endo-Surgery) using a thoracoscopic technique (Wolf technique). Results. MICABG was completed in 46 (90%) patients without cardiopulmonary bypass. Cardiopulmonary bypass was used in 5 patients (3 with small coronary arteries and 2 with intramyocardial arteries), in 3 of whom additional median sternotomies were made. One patient (2.0%), who suffered a pre-operative stroke, expired of stroke progression on the second postoperative day. Each of the IMA pedicles was completely dissected by means of the Wolf technique and 3-month postoperative Doppler studies were used to confirm patency. Conclusion. MICABG is a feasible and viable alternative surgical revascularisation procedure in selected patients with obstructive coronary disease. A new technique for thoracoscopic dissection of the IMA can facilitate the procedure.
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