Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Minimally Invasive Coronary Artery Bypass Grafting
See to on ExpertConsult.com .
Minimally Invasive Cardiac Surgery–Coronary Artery Bypass Grafting (MICS CABG)
- ◆
This technique enables revascularization with a similar configuration as that in a sternotomy technique, using left internal thoracic artery (LITA) harvesting and hand-sewn proximal and distal anastomoses under direct visualization. Complete revascularization is achieved in 95% of cases, allowing access to the anterior, lateral, and inferior walls of the heart, with or without the use of pump assistance.
Step 1
Surgical Anatomy
- ◆
Anatomic considerations are the same as those for a standard median sternotomy, except that the view is now from the apical position through a small left thoracotomy window.
Step 2
Preoperative Considerations
1
Indications
- ◆
These follow the current guidelines for coronary revascularization.
2
Contraindications
- ◆
Hemodynamic instability or acute ischemia
- ◆
Chest wall deformities and significant pleural adhesions
- ◆
Obesity
- ◆
Intolerance to single-lung ventilation
- ◆
Significant ascending aorta calcification, if aortic proximal anastomoses are planned
- ◆
Poor status of the femoral vessels for peripheral cardiopulmonary bypass (CPB) cannulation, whether planned or not
- ◆
Inadequate distal target size and quality. The right coronary artery and proximal posterior interventricular (PIV), posterolateral (PL), and proximal obtuse marginal (OM) targets are not easily accessible.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here
