New minimally invasive surgical technique using arterial T-grafts for treatment of double-vessel coronary artery disease: Experimental study

Minimally invasive surgery has been used successfully in patients with sing le-vessel coronary artery disease (CAD), but there are no clinical reports of surgical techniques for the treatment of multivessel disease in this fie ld using both internal mammary arteries (IMAs). Therefore a canine model ha s been established to demonstrate the feasibility of a minimally invasive s urgical treatment of coronary artery double-vessel disease using both IMAs. Ten mongrel dogs underwent bilateral thoracoscopic preparation of both int ernal mammary arteries through small left lateral chest ports. Using the Po rt Access endovascular cardiopulmonary bypass system the right IMA (RIMA) n as anastomosed as a free graft end-to-side to the left IMA (RIMA) as a T-gr aft, After induction of cardioplegic arrest the RIMA a as anastomosed to th e circumflex artery and the LIMA to the left anterior descending artery. Al l animals were weaned from cardiopulmonary bypass without inotropic support . The electrocardiogram showed sinus rhythm with no signs of ischemia. Intr aoperative coronary angiography demonstrated patency of all anastomoses. Th e minimally invasive surgical treatment of double-vessel CAD using arterial T-grafts of both IMAs is thus feasible. Surgical trauma can be further red uced by harvesting the RIMA transmediastinally through the left lateral che st.