F G Duhaylongsod1, W R Mayfield, R K Wolf. 1. Division of Cardiothoracic Surgery, Durham Veterans Administration Medical Center, North Carolina, USA. duhay001@mc.duke.edu
Abstract
BACKGROUND: Off-pump bypass grafting most commonly involves harvest of the left internal thoracic artery (ITA) through a minithoracotomy under direct vision. Disadvantages to this approach, however, include poor exposure, incomplete dissection resulting in inadequate ITA length, and significant postoperative pain because of rigorous chest retraction. This study determined the safety and efficacy of an alternative to direct ITA harvest using a thoracoscopic approach. METHODS: Two hundred eighteen patients at three institutions underwent thoracoscopic ITA harvest; 118 (54%) for off-pump coronary bypass grafting. RESULTS: The left ITA was harvested in 211 patients (96%); the mean harvest time ranged from 42 to 55 minutes. The ITA was injured in 4 patients (1.8%), and conversion to open ITA harvest occurred in 18 (8%). Complications included intercostal neuropathy (4), reoperation for ITA bleeding (2), phrenic nerve injury (1), and wound infection (1). CONCLUSIONS: This large, multicenter experience demonstrates that thoracoscopic harvest of the ITA can be accomplished safely and within a reasonable time frame in most patients undergoing coronary bypass grafting.
BACKGROUND: Off-pump bypass grafting most commonly involves harvest of the left internal thoracic artery (ITA) through a minithoracotomy under direct vision. Disadvantages to this approach, however, include poor exposure, incomplete dissection resulting in inadequate ITA length, and significant postoperative pain because of rigorous chest retraction. This study determined the safety and efficacy of an alternative to direct ITA harvest using a thoracoscopic approach. METHODS: Two hundred eighteen patients at three institutions underwent thoracoscopic ITA harvest; 118 (54%) for off-pump coronary bypass grafting. RESULTS: The left ITA was harvested in 211 patients (96%); the mean harvest time ranged from 42 to 55 minutes. The ITA was injured in 4 patients (1.8%), and conversion to open ITA harvest occurred in 18 (8%). Complications included intercostal neuropathy (4), reoperation for ITA bleeding (2), phrenic nerve injury (1), and wound infection (1). CONCLUSIONS: This large, multicenter experience demonstrates that thoracoscopic harvest of the ITA can be accomplished safely and within a reasonable time frame in most patients undergoing coronary bypass grafting.