Kikuchi Keita, Endo Yoshiki
From the *Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China; and †Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato City, Japan.
Innovations (Phila). 2017 May/Jun;12(3):224-226. doi: 10.1097/IMI.0000000000000366.
We introduce assistive techniques for proximal anastomosis in off-pump minimally invasive coronary artery bypass grafting (MICS CABG) to overcome difficult access to the ascending aorta in MICS CABG. An 8-cm left thoracotomy is made in the fifth intercostal space. ThoraTrak retractor (Medtronic Inc, Minneapolis, MN USA) is used to open the thoracotomy and is pulled to the cephalad and rightward direction toward to the ascending aorta. The pericardium is opened from the ascending aorta to the left ventricular apex and to the inferior vena cava. Two retraction sutures on the pericardial edge are used to laterally displace the heart. After dissecting between the ascending aorta and main pulmonary artery, the Octopus tissue stabilizer (Medtronic Inc, Minneapolis, MN USA), of which the suction tip is bent 60 degrees, is used to retract the pulmonary artery caudally. A flexible side-biting clamp (Vitalitec Inc.) is placed on the ascending aorta, and proximal anastomoses are handsewn on the ascending aorta. A total of 31 proximal anastomoses were completed with this technique between November 2013 and June 2015. All proximal anastomosis was completed without any difficulty. In MICS CABG, the technical challenges in proximal anastomosis due to difficult access to the aorta can be overcome safely by using this technique.
我们介绍非体外循环微创冠状动脉旁路移植术（MICS CABG）中近端吻合的辅助技术，以克服MICS CABG中升主动脉显露困难的问题。在第五肋间做一个8厘米的左胸切口。使用Thoratrak牵开器（美敦力公司，美国明尼阿波利斯，MN）打开胸壁切口，并将其向头侧和右侧拉向升主动脉。心包从升主动脉至左心室尖和下腔静脉打开。心包边缘的两根牵引缝线用于将心脏向外侧移位。在升主动脉和主肺动脉之间进行解剖后，使用吸盘尖端弯曲60度的章鱼组织稳定器（美敦力公司，美国明尼阿波利斯，MN）将肺动脉向尾侧牵拉。在升主动脉上放置一个柔性侧咬钳（Vitalitec公司），近端吻合在升主动脉上手工缝合。2013年11月至2015年6月期间，使用该技术共完成了31例近端吻合。所有近端吻合均顺利完成。在MICS CABG中，通过使用该技术可以安全地克服由于主动脉显露困难导致的近端吻合技术挑战。
