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J Thorac Cardiovasc Surg 1996;111:567-573
© 1996 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
Funded in part by a grant from Heartport, Inc., Redwood City, Calif.
Received for publication Nov. 7, 1995 Revisions requested Nov. 17, 1995; revisions received Dec. 12, 1995 Accepted for publication Dec. 13, 1995. Address for reprints: Lawrence C. Siegel, MD, Stanford University School of Medicine, 300 Pasteur Dr., Stanford, CA 94305-5117.
Abstract
Minimally invasive surgical methods have been developed to provide patients the benefits of open operations with decreased pain and suffering. We have developed a system that allows the performance of cardiopulmonary bypass and myocardial protection with cardioplegic arrest without sternotomy or thoracotomy. In a canine model, we successfully used this system to anastomose the internal thoracic artery to the left anterior descending coronary artery in nine of 10 animals. The left internal thoracic artery was dissected from the chest wall, and the pericardium was opened with the use of thoracoscopic techniques and single lung ventilation. The heart was arrested with a cold blood cardioplegic solution delivered through the central lumen of a balloon occlusion catheter (Endoaortic Clamp; Heartport, Inc., Redwood City, Calif.) in the ascending aorta, and cardiopulmonary bypass was maintained with femorofemoral bypass. An operating microscope modified to allow introduction of the 3.5x magnification objective into the chest was positioned through a 10 mm port over the site of the anastomosis. The anastomosis was performed with modified surgical instruments introduced through additional 5 mm ports. In the cadaver model (n= 7) the internal thoracic artery was harvested and the pericardium opened by means of similar techniques. A precise arteriotomy was made with microvascular thoracoscopic instruments under the modified microscope on four cadavers. In three other cadavers we assessed the exposure provided by a small anterior incision (4 to 6 cm) over the fourth intercostal space. This anterior port can assist in dissection of the distal internal thoracic artery and provides direct access to the left anterior descending, circumflex, and posterior descending arteries. We have demonstrated the potential feasibility of grafting the internal thoracic artery to coronary arteries with the heart arrested and protected, without a major thoracotomy or sternotomy. (J THORACCARDIOVASCSURG1996;111:567-73)
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D. S. Schwartz, G. H. Ribakove, E. A. Grossi, J. D. Schwartz, P. M. Buttenheim, F. G. Baumann, S. B. Colvin, and A. C. Galloway SINGLE AND MULTIVESSEL PORT-ACCESS CORONARY ARTERY BYPASS GRAFTING WITH CARDIOPLEGIC ARREST: TECHNIQUE AND REPRODUCIBILITY J. Thorac. Cardiovasc. Surg., July 1, 1997; 114(1): 46 - 52. [Abstract] [Full Text]
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H. Shennib, M. J. Mack, and A. G. L. Lee A Survey on Minimally Invasive Coronary Artery Bypass Grafting Ann. Thorac. Surg., July 1, 1997; 64(1): 110 - 114. [Abstract] [Full Text]
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W. S. Peters, L. C. Siegel, J. H. Stevens, F. G. St. Goar, M. F. Pompili, and T. A. Burdon Closed-Chest Cardiopulmonary Bypass and Cardioplegia: Basis for Less Invasive Cardiac Surgery Ann. Thorac. Surg., June 1, 1997; 63(6): 1748 - 1754. [Abstract] [Full Text]
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D. S. Schwartz, G. H. Ribakove, E. A. Grossi, P. M. Buttenheim, J. D. Schwartz, R. M. Applebaum, I. Kronzon, F. G. Baumann, S. B. Colvin, and A. C. Galloway MINIMALLY INVASIVE MITRAL VALVE REPLACEMENT: PORT-ACCESS TECHNIQUE, FEASIBILITY, AND MYOCARDIAL FUNCTIONAL PRESERVATION J. Thorac. Cardiovasc. Surg., June 1, 1997; 113(6): 1022 - 1031. [Abstract] [Full Text]
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P. J. Lin, C.-H. Chang, J.-J. Chu, H.-P. Liu, F.-C. Tsai, F.-C. Lin, C.-W. Chiang, M.-W. Yang, and P. P. C. Tan Video-Assisted Coronary Artery Bypass Grafting During Hypothermic Fibrillatory Arrest Ann. Thorac. Surg., April 1, 1997; 63(4): 1113 - 1117. [Abstract] [Full Text]
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J. M Toomasian, W. S Peters, L. C Siegel, and J. H Stevens Extracorporeal circulation for port-access cardiac surgery Perfusion, March 1, 1997; 12(2): 83 - 91. [Abstract] [PDF]
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L. P. Perrault, P. Menasche, J.-P. Bidouard, C. Jacquemin, N. Villeneuve, J.-P. Vilaine, and P. M. Vanhoutte Snaring of the Target Vessel in Less Invasive Bypass Operations Does Not Cause Endothelial Dysfunction Ann. Thorac. Surg., March 1, 1997; 63(3): 751 - 755. [Abstract] [Full Text]
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 H. Reichenspurner, V. Gulielmos, W. G. Daniel, and S. Schuler Minimally Invasive Coronary-Artery Bypass Surgery N. Engl. J. Med., January 2, 1997; 336(1): 67 - 68. [Full Text]
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A. M. Calafiore, G. D. Angelini, J. Bergsland, and T. A. Salerno Minimally Invasive Coronary Artery Bypass Grafting Ann. Thorac. Surg., November 1, 1996; 62(5): 1545 - 1548. [Abstract] [Full Text]
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M. F. Pompili, J. H. Stevens, T. A. Burdon, L. C. Siegel, W. S. Peters, G. H. Ribakove, and B. A. Reitz PORT-ACCESS MITRAL VALVE REPLACEMENT IN DOGS J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1268 - 1274. [Abstract] [Full Text]
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J. H. Stevens, T. A. Burdon, L. C. Siegel, W. S. Peters, M. F. Pompili, F. G. St. Goar, G. J. Berry, G. H. Ribakove, M. A. Vierra, R. S. Mitchell, et al. Port-Access Coronary Artery Bypass With Cardioplegic Arrest: Acute and Chronic Canine Studies Ann. Thorac. Surg., August 1, 1996; 62(2): 435 - 440. [Abstract] [Full Text]
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