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DOI: 10.1055/s-0037-1598704
Off-Pump Bilateral Internal Mammary Artery Grafting Through a Left-Sided Mini-Thoracotomy
Publication History
Publication Date:
03 February 2017 (online)
Background: Coronary artery bypass grafting (CABG) using bilateral internal mammary artery (BIMA) is associated with superior long-term survival. However, using BIMA is considered to increase sternal wound infections. We here describe a new technique for harvesting and grafting BIMA off-pump through a left-sided mini-thoracotomy.
Methods: In all cases, the incision was similar to that of standard minimally invasive direct coronary artery bypass grafting (MIDCAB) but slightly more lateral. With the use of double-lumen ventilation, left and right-lung ventilation was alternated with short intervals of apnea if necessary. The right internal mammary artery (RIMA) was used either in situ or as T-graft from the left internal mammary artery (LIMA). All operations were performed off-pump. An arterial and a venous wire were inserted in the left groin in case conversion to on-pump would have been necessary. For follow-up, we used the coronary revascularization outcome questionnaire (CROQ).
Results: Between February and August 2016, we performed 15 Mini-Off-Pump BIMA cases. The mean duration of operation was 241 ± 54 minute. In 4 patients, the RIMA was used in situ to revascularize the left anterior descending artery (LAD), while in the other 11 patients it was used as T-graft from the LIMA to revascularize the obtuse marginal arteries or the posterior descending artery. There was no intraoperative complication. No conversion to sternotomy or on-pump was required. One patient required a re-thoracotomy for postoperative bleeding. Due to elevated troponin levels postoperatively in two patients, cardiac catheterization followed by percutaneous coronary intervention was done. In both cases, the RIMA was used in situ to revascularize the LAD and a kink in the graft impaired myocardial perfusion. The median duration of follow-up was 46 with a maximum of 192 days. There was no mortality during hospital stay or follow-up. Postoperative stress ECG was normal in all patients. Relief of angina was achieved in all patients. There was one readmission for superficial wound infection which was conservatively treated.
Conclusion: Myocardial revascularization using bilateral internal mammary artery can be safely achieved off-pump through a left-sided mini-thoracotomy with good postoperative and short-term outcome. The results further suggest that using the right internal mammary artery as T-graft might be superior to using it in situ.