| Lower Mini-Sternotomy
for Direct Coronary Artery Bypass on the Beating Heart |
(Department of Thoracic and Cardiovascular Surgery,
Juntendo University, Tokyo, Japan)
| Taira Yamamoto |
Yasuyuki Hosoda |
Shiro Sasaguri |
| Kenji Takazawa |
Masahiro Goto |
Shiori Kawasaki |
| Motoshige Yamasaki |
Hiroshi Sato |
Tomonobu Fukuda |
|
Although left anterior descending
coronary artery (LAD) grafting with a left internal thoracic
artery (ITA) on a beating heart via a small left anterior thoracotomy
(LAST) has become widely accepted, significant limitations exist
due to the limited surgeon experience, smallness of exposure,
thus making harvesting of the ITA, visualization of the surgical
field and anastomosis quite difficult. Patients often have significant
pain and wound complications postoperatively. A lower mini-sternotomy
approach in 4 patients was performed from December 1998 through
January 1999. Results: The length of mini-sternotomy incision
is 7 to 14cm. These operations were accomplished without morbidity
or mortality. No patients required intraoperative conversion
to conventional bypass. Postoperative angiography showed patency
of graft without stenosis of the anastomosis in all 4 patients.
The patients did not complain of significant pain and their postoperative
hospital stay was 5 to 11 days. The lower mini-sternotomy approach
or “xyphoid” approach proposed by Benetti seems to be an excellent
novel approach giving the freedom of extension of the incision
if needed with satisfactory exposure for left ITA harvest and
access to LAD as well as the distal RCA, and causes less postoperative
incisional pain.
Jpn. J. Cardiovasc. Surg. 29: 21-24 (2000) |
|
