ABSTRACT 44

REVASCULARIZATION THROUGH LATERAL THORACOTOMY, SRIVASTAVA APPROACH. A REPORT OF FIRST 100 CONSECUTIVE CASES.

Sudhir P. Srivastava, MD,   Kirit N. Patel, MD,   Prasad Tumula, MD, Reyna L. Barrera, PA-S,   Diana Nanayakkara, CCRN,   Krissy Hamilton, RN,   Charu Gupta,   Madhu Kovelmudi, CCP,  Moui Ngyuen, CP

BACKGROUND: Cardiopulmonary bypass and median sternotomy have been recognized as major morbidity factors in cardiac surgery. The author has developed an innovative technique to perform complete revascularization without cardiopulmonary bypass and median sternotomy.

METHODS: Since February 2000, 100 patients have undergone off pump total revascularization through left lateral thoracotomy. The number of grafts ranged from one to five with a mean of 3 grafts per patient. Patient is positioned with left side elevated to 45  . A five to six inch incision is made over the left 4th or 5th intercostal space. The LIMA is taken down directly as a pedicle. Proximal anastomoses are done on the ascending aorta followed by distal anastamoses on a beating heart using a stabilizer.

RESULTS: There was no mortality, CVA or respiratory failure. None required conversion to cardiopulmonary bypass and planned total revascularization was successful in all patients. Two (2 %) patients required re-exploration for chest wall bleeding.

CONCLUSION: Total revascularization without cardiopulmonary bypass and median sternotomy is feasible. Reduction in morbidity associated with CPB and median sternotomy allows for early return to normal activities. Significant reduction in new onset atrial fibrillation was noted. The approach offers another very attractive alternative for off pump CABG.