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ABSTRACT 67
THORACOSTERNOTOMY FOR OFF-PUMP CORONARY ARTERY
BYPASS
Charles S. Drummond, III, M.D., Stephen W. Downing, M.D.
University of Maryland, Baltimore, USA
Background: Multivessel off-pump bypass (OP-CAB) via
sternotomy is ideal for high-risk patients. However, in those
with cardiomegally and a reduced EF, safe exposure of the lateral
wall is not always possible.
Hypothesis: A left anterior thoracosternotomy (LATS) provides
adequate exposure of all coronary targets with less cardiac displacement
than sternotomy, facilitating OP-CAB in patients with large hearts
and poor function.
Methods: Left 4th or 5th anterior
thoracotomy with transverse sternal division. Standard IMA harvest
and OP-CAB technique. Saphenous vein grafts (SVG) anastomosed
to ascending aorta. Patients were selected by perceived inability
to graft lateral targets via sternotomy.
Results: All patients had a cardiac/thoracic ratio of
> .5. Mean EF 27±15, with 2.8 grafts/patient. There was no
hemodynamic instability, sternal complications or mortality (n=4).
Details:
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Case
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EF
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Grafts
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1:
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.10
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SVG to Diagonal. to LAD, SVG to OM
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2:
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.45
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LIMA to LAD, SVG to Diagonal., SVG to OM
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3:
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.35
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LIMA to LAD, SVG to RCA, SVG to OM
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4:
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.20
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LIMA to LAD, SVG to OM
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Conclusions: A LATS approach facilitated OP-CAB in high-risk
patients with cardiomegally and poor cardiac function.
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