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I. CURRENT INDICATIONS FOR MYOCARDIAL REVASCULARIZATION  THE MULTIFOCAL ATHEROSCLEROTIC PATIENT
DIAGNOSIS AND MANAGEMENT IN 2003


The Journal of Cardiovascular Surgery 2003 June;44(3):319-22

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Indications for off pump coronary surgery

Benetti F. 1, Patel A. N. 2, Hamman B. 2

1 Benetti Foundation, Buenos Aires, Argentina
2 Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, TX, ­USA


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The learn­ing ­curve in ­off ­pump sur­gery ­must be fol­lowed ­due to ­the ­fact ­that beat­ing ­heart cor­o­nary sur­gery is a com­plete­ly dif­fer­ent oper­a­tion. Beating ­heart cor­o­nary sur­gery is tru­ly a ­team ­approach. Both ­the sur­geon ­and ­the anes­the­sio­lo­gist ­must ­work in con­cert to ­attain a ­smooth, ­safe ­and effi­cient oper­a­tion. A ster­not­o­my is per­formed. All con­duits ­are har­vest­ed as ­for tra­di­tion­al cor­o­nary ­artery ­bypass graft­ing (­CABG). The per­i­car­di­um is ­opened ­using a “hock­ey ­stick” inci­sion. Another inci­sion is ­made to com­plete ­the reflec­tion of ­the per­i­car­di­um ­from ­the pul­mo­nary ­artery to ­the aor­ta. The ­heart is ­then repo­si­tioned ­with ­the ­surgeon’s ­hand ­and expo­sure ­device is ­placed at ­the ­apex of ­the ­heart. Additional per­i­car­dial ­sutures ­may ­place ­for posi­tion­ing as need­ed ­for expo­sure to com­plete ­the oth­er anas­tom­o­sis ­using sta­bi­liz­ers. The ­left inter­nal mam­mary ­artery (LIMA) to ­left ante­ri­or descend­ing ­artery (­LAD) ­graft is per­formed ­first, ­after ­the pos­te­ro-lat­er­al ­wall or ­the ­right ­side of ­the ­heart ­can be revas­cu­lar­ized. After ­each anas­tom­o­sis is per­formed, meas­ure­ment of ­the ­flow ­through ­the con­duit is rec­om­mend­ed. The ­chest is ­closed in ­the stan­dard fash­ion. Off ­pump cor­o­nary ­artery graft­ing ­has ­been estab­lished as a ­safe ­and effec­tive pro­ce­dure. It ­involves a total­ly dif­fer­ent ­mind-­set ­for ­the sur­geon. Indication ­for ­off ­pump cor­o­nary sur­gery ­depends on ­the expe­ri­ence ­and com­fort lev­el of ­the sur­geon. Currently, ­there ­are a mul­ti­tude of devic­es avail­able ­for ­both expo­sure ­and sta­bil­iza­tion to effi­cient­ly per­form ­this oper­a­tion. Therefore, ­most ­patients ­should be con­sid­ered can­di­dates ­for ­off ­pump cor­o­nary revas­cu­lar­iza­tion.

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