SINGLE AND MULTIVESSEL PORT-ACCESS CORONARY-ARTERY BYPASS-GRAFTING WITH CARDIOPLEGIC ARREST - TECHNIQUE AND REPRODUCIBILITY

Objectives: Although minimally invasive coronary artery bypass graftin g is now feasible, using this technique to perform anastomoses on the beating or fibrillating heart may yield poorer graft patency than the standard open techniques that use cardioplegic arrest, This study test ed the feasibility and anastomotic reproducibility of minimally invasi ve coronary bypass using newly developed port-access coronary artery b ypass technology (Heartport, Inc., Redwood. City, Calif,), which allow s endovascular cardiopulmonary bypass, cardiac venting, aortic occlusi on, and cardioplegic arrest for internal thoracic artery-coronary arte ry anastomoses, Methods: Nineteen dogs had thoracoscopic takedown of e ither single (n = 14) or bilateral (n = 5) internal thoracic arteries followed by minimally invasive coronary bypass,vith cardioplegic arres t, done by means of the port-access system, The anastomotic technique was modified after the fourth animal by switching from a microscope to a 2.5 cm oval port acid performing a conventional anastomosis with op erative loupes, The adequacy of delivery of cardioplegic solution, ven tricular decompression, and anastomotic patency was assessed, Results: The crossclamp and bypass times were 50 +/- 15 minutes and 87 +/- 28 minutes (mean +/- standard deviation), respectively, The mean myocardi al temperature after cardioplegia was 17 degrees +/- 1 degrees C and t he aortic pressure (-3 +/- 9 mm Hg) and pulmonary artery pressure (4 /- 1 rum Hg) were low throughout the procedure, All animals were weane d from bypass without inotropic agents, Angiograms and autopsies demon strated successful thoracic artery takedown and anastomotic patency in 15 of 19 animals, dth 100% anastomotic patency after the technique ha d been modified after the fourth animal, Conclusion: This study descri bes a reproducible technique for minimally invasive coronary bypass th at allows myocardial protection, anastomotic precision, and predictabl e thoracic artery graft patency, Clinical trials are indicated.