MYOCARDIAL REVASCULARIZATION THROUGH A MINI-THORACOTOMY WITH THORACOSCOPIC ASSISTANCE

Objective: Left internal mammary artery harvesting through a mini-thor acotomy makes gaining the proximal portion of this vessel very difficu lt and exposes the patient to the risk of chest wall trauma due to exc essive spreading of the ribs. The adoption of video thoracoscopic assi stance can give several advantages to the procedure. Methods: With the patient in a 30 degrees left-side-up thoracotomy position, a 8-12 cm anterior thoracotomy is performed in the left fourth or fifth intercos tal space. Two thoracoscopic ports are inserted in the third and fourt h left intercostal spaces in the midaxillary line. Complete mobilizati on of the left internal mammary artery is performed with a mixed surgi cal and thoracoscopic technique. Results: Since July 1996, 12 patients underwent myocardial revascularization with the left internal mammary artery through a mini-thoracotomy, with the aid of video assisted tho racoscopy. There were no deaths or perioperative infarctions. Mean hos pital stay was 4 days (3-6). In nine patients a postoperative angiogra phic study was performed: in all cases the length of the mammary arter y pedicle was adequate; one patient underwent a successful angioplasty on it narrowed anastomosis on the left anterior descending artery. in another patient the left internal mammary artery had been grafted to a diagonal branch. In all other cases angiography showed good results. Conclusions: Thoracoscopic assistance helps achieving complete mobili zation of the left internal mammary artery, maximizing its useful leng th, without an extended thoracotomy. (C) 1998 Elsevier Science B.V. Al l rights reserved.