oa Cardiovascular Journal of Africa - Our experience with minimally invasive coronary artery bypass grafting and thoracoscopic internal mammary artery harvest with the Harmonic scalpel
|Article Title||Our experience with minimally invasive coronary artery bypass grafting and thoracoscopic internal mammary artery harvest with the Harmonic scalpel|
|© Publisher:||Clinics Cardive Publishing|
|Journal||Cardiovascular Journal of Africa|
|Affiliations||1 Department of Cardiac Surgery, The Christ and Jewish Hospitals and Department of Surgery, University of Cincinnati, USA|
|Publication Date||Oct 1997|
|Pages||285 - 288|
|Keyword(s)||Cardiology, Cardiothoracic surgery, Harmonic scalpel, Minimally invasive coronary artery bypass grafting, Results, Revascularisation, Target vessels and grafts and Wolf technique|
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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