Document Detail

Xiphoid lower-sternotomy approach for multivessel revascularization of the left internal mammary artery to the left anterior descending artery and right internal mammary artery inflow to the other vessels.
MedLine Citation:
PMID:  20150038     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We describe the technical details and the preliminary results of a new surgical approach for multivessel disease that involves using a lower T sternotomy, grafting of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) and use of the right internal mammary artery (RIMA) as inflow to the other vessels.
OPERATIVE TECHNIQUE: The sternotomy was made from the xiphoid up to the fourth intercostal space and then was continued transversally (T incision). The LIMA was harvested for a length of approximately 8 cm, with preservation of the distal part. The vein was simultaneously taken from the leg. The RIMA was dissected for a length of approximately 5 cm, and the distal part was occluded. Then, 3 mg/kg heparin was given. The anastomosis between the vein and the RIMA was performed. The distal venous anastomoses were done either singly or sequentially. The anterior or posterior route was chosen according to the patient's anatomy. The LIMA was then anastomosed to the LAD. One drain was placed. The sternum was closed with 4 wires, 2 for the T incision and 2 for the sternum.
RESULTS: Between September and December 2008, 9 patients underwent their operations with this technique. The mean age was 60 years (range, 55-68 years). The mean number of grafts was 2.8. The mean hospital stay was 5.2 days. Operative mortality was 0%. All patients were reevaluated with 16-slice multislice computed tomography, and all grafts were patent. At the 3-month follow-up, all patients were alive and free of symptoms.
CONCLUSION: This minimally invasive technique is a useful alternative for complete revascularization. The sternal mammary supply and the upper part of the sternum are preserved.
Federico Benetti; Sotirios Prapas; Ernesto Angeletti; Jose Luis Ameriso; Eduardo Cicalle; Tomislav Klokocovnik; Ivan Knezevic; Borut Gersak
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The heart surgery forum     Volume:  13     ISSN:  1522-6662     ISO Abbreviation:  Heart Surg Forum     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-12     Completed Date:  2010-05-07     Revised Date:  2011-08-25    
Medline Journal Info:
Nlm Unique ID:  100891112     Medline TA:  Heart Surg Forum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E36-9     Citation Subset:  IM    
Benetti Foundation, Rosario, Argentina.
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MeSH Terms
Anastomosis, Surgical / instrumentation,  methods*
Blood Vessel Prosthesis*
Coronary Artery Disease / surgery*
Mammary Arteries / surgery*
Middle Aged
Myocardial Revascularization / instrumentation,  methods*
Pilot Projects
Sternotomy / methods*
TNF Receptor-Associated Factor 6
Treatment Outcome
Xiphoid Bone / surgery
Reg. No./Substance:
0/TNF Receptor-Associated Factor 6

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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