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Title
1. Introduction
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a. Prepare and Position Patient
2. Exposure to Identify Target
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a. Perform Left 3-Inch Mini Thoracotomy in the 5th Intercostal Space
b. Enter 5th Intercostal Space
c. Mobilize Fat Pad
d. Open Pericardium
e. Palpate for Anastomosis Site
3. Assessment of Target
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a. Assess Left Anterior Descending Coronary Artery Quality and Size
b. Identify Diagonal Branch
4. Harvest of Left Internal Mammary Artery (LIMA)
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a. Identify Lateral Mammary Vein
b. Divide Fascia
c. Identify Mammary Artery
d. Expose Distal Aspect of Mammary
e. Insert LIMA Lift
f. Incise Intrathoracic Fascia over the Mammary Artery for Hemiskeletonization
g. Modify Placement of LIMA Lift
h. Optimize Exposure through Small Adjustment on LIMA Lift Retractor
i. Divide Mammary Artery
j. Test Flow of Conduit
5. Anastomosis
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a. Tack Mammary to Edge of Incision
b. Prepare Mammary
c. Proximal Occlusion of the Left Anterior Descending Coronary Artery
d. Stabilize LAD
e. Perform End-to-Side LIMA to LAD Anastomosis Using Separate Heel-and-Toe Technique with 8-0 Prolene
f. Arteriotomy
g. Place Intracoronary Shunt of Approriate Size
h. Perform Anastomosis
i. Parachute the Mammary Artery Down
j. Complete Anastomosis
k. Retrieve Shunt
l. Open Mammary Artery
6. Graft Patency Verification with Transit-Time Flowmeter
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a. Reapproximate Mediastinal Fat over Pericardiotomy
b. Perform Intercostal Nerve Cryoablation for Pain Control
c. Insert Chest Tube
d. Wound Closure
7. Post-op Remarks
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Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
Ory Wiesel, MD
;
Marco Zenati, MD
VA Boston Healthcare System
Tags:
Cardiac Surgery
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Authors
Ory Wiesel, MD
Marco Zenati, MD
Filmed At:
VA Boston Healthcare System
Article Information
Publication Date
10/2/2024
Article ID
180
Production ID
0180
Volume
2024
Issue
180
DOI
https://doi.org/10.24296/jomi/180