Jh. Stevens et al., PORT-ACCESS CORONARY-ARTERY BYPASS-GRAFTING - A PROPOSED SURGICAL METHOD, Journal of thoracic and cardiovascular surgery, 111(3), 1996, pp. 567-573
Minimally invasive surgical methods have been developed to provide pat
ients the benefits of open operations with decreased pain and sufferin
g. We have developed a system that allows the performance of cardiopul
monary bypass and myocardial protection with cardioplegic arrest witho
ut sternotomy or thoracotomy. In a canine model, we successfully used
this system to anastomose the internal thoracic artery to the left ant
erior descending coronary artery in nine of 10 animals, The left inter
nal thoracic artery was dissected from the chest wall, and the pericar
dium was opened with the use of thoracoscopic techniques and single lu
ng ventilation, The heart was arrested with a cold blood cardioplegic
solution delivered through the central lumen of a balloon occlusion ca
theter (Endoaortic Clamp; Heartport, Inc., Redwood City, Calif,) in th
e ascending aorta, and cardiopulmonary bypass was maintained with femo
rofemoral bypass, An operating microscope modified to allow introducti
on of the 3.5x magnification objective into the chest was positioned t
hrough a 10 mm port over the site of the anastomosis, The anastomosis
was performed with modified surgical instruments introduced through ad
ditional 5 mm ports, In the cadaver model (n = 7) the internal thoraci
c artery was harvested and the pericardium opened by means of similar
techniques, A precise arteriotomy was made with microvascular thoracos
copic instruments under the modified microscope on four cadavers, In t
hree other cadavers we assessed the exposure provided by a small anter
ior incision (4 to 6 cm) over the fourth intercostal space. This anter
ior port can assist in dissection of the distal internal thoracic arte
ry and provides direct access to the left anterior descending, circumf
lex, and posterior descending arteries, We have demonstrated the poten
tial feasibility of grafting the internal thoracic artery to coronary
arteries with the heart arrested and protected, without a major thorac
otomy or sternotomy.