ABSTRACT 60

PARTIAL STERNOTOMY AS A MINIMAL ACCESS FOR OFF-PUMP CABG:  FEASIBILITY OF THE LOWER STERNAL SPLITTING APPROACH

Hiroshi Niinami, Yasou Takeuchi, Seiichi Ichikawa, Yuji Suda
Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Daini Hospital, Tokyo, Japan

Background:  OPCAB can be performed in several ways using a minimally invasive approach.  Using LAST approach, only the LAD can be grafted.  We have employed a partial sternotomy without a transverse cut.  Through this approach, the LAD and RCA can be revascularized via a single small incision without the risk of damaging the tissue around the intercostal space when the sternum is transversely divided.  This study is to demonstrate the feasibility and safety of this technique.

Methods:  Since November 1999, we have applied OPCAB through a lower midline skin incision from the 4^th intercostal space to the xiphisternum with longitudinal division of the lower half sternum up to the 3^rd intercostal space, without making either a T- or reversed-J shaped division of the sternum.  A total of 20 patients (pts) have undergone surgery using this approach.  Mean age was 70.1 ± 4.2 years (range 58-78).

Results:  Mean length of the skin incision was 8.6 ± 1.1 cm (range 8-12).  No hospital death or morbidity was observed.  All pts had arterial conduits:  LIMA, 19 pts;  RIMA, 2 pts;  RGEA, 4 pts;  and RA, 1 pt.  Mean number of grafts per pt was 1.3 ± 0.3 (range 1-3).  The patency rate was 96.2 %.

Conclusions:  Our experience demonstrates that the lower sternal splitting approach for OPCAB is technically feasible and can be used with excellent cosmetic results and safety.  Although experience is limited, this less invasive surgical technique can be used as an alternative approach for MIDCAB in pts with LAD and/or RCA disease.