Background. It has been stated that thoracoscopic internal thoracic artery (ITA) mobilization is not recommended in the redo minimally invasive direct coronary artery bypass (FI MIDCAB) situation, presumably because a...
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Background. It has been stated that thoracoscopic internal thoracic artery (ITA) mobilization is not recommended in the redo minimally invasive direct coronary artery bypass (FI MIDCAB) situation, presumably because adhesions from the previous coronary artery bypass grafting operation may preclude a thoracoscopic approach. However, there are advantages to thoracoscopic ITA mobilization in MIDCAB that could also be realized in the redo situation. Methods. In 200 MIDCAB procedures over the last 3 and a half years, 11 patients, ages 49-83 (mean 69), were identified as having undergone an attempted ITA mobilization in a redo situation. Results. Thoracoscopic ITA mobilization was successful in 9 out of 11 patients (81%). One patient had complete pleural symphysis precluding this approach, and 1 patient had poor mammary now after harvest and this conduit was not used. Both failures were in female octogenarians. Conclusions. To realize the advantages of a tharacoscopic ITA mobilization MIDCAB, both right and left thoracoscopic ITA mobiIization can safely be performed in the redo situation. Thoracic adhesions precluding a thoracoscopic approach were encountered in only 1 of 11 redo coronary artery bypass grafting patients. (C) 1999 by The Society of Thoracic Surgeons.
Background. The purpose of this study was to examine the feasibility of performing totally endoscopic myocardial revascularization through the abdominal cavity. Methods and Results. The right gastroepiploic artery was...
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Background. The purpose of this study was to examine the feasibility of performing totally endoscopic myocardial revascularization through the abdominal cavity. Methods and Results. The right gastroepiploic artery was harvested endoscopically through three troacars in 46 human cadavers. Then, a 5-cm hole was made in the diaphragm to expose the right coronary artery. With the help of two vacuum pods, we fixed a site of the right coronary artery and made a right gastroepiploic artery-right coronary artery anastomosis. In 20 cases, continuous Prolene suture was used, and in 26 experiments, we applied a sutureless technique. Twenty-three anastomosis were patent. Conclusions. Despite the low patency rate, the transabdominal approach of totally endoscopic bypass grafting is promising and demands further investigation. (C) 1999 by The Society of Thoracic Surgeons.
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