Single and multivessel port-access coronary artery bypass grafting with cardioplegic arrest: Technique and reproducibility

Abstract

Objectives: Although minimally invasive coronary artery bypass grafting is now feasible, using this technique to perform anastomoses on the beating or fibrillating heart may yield poorer graft patency than the standard open techniques that use cardioplegic arrest. This study tested the feasibility and anastomotic reproducibility of minimally invasive coronary bypass using newly developed port-access coronary artery bypass technology (Heartport, Inc., Redwood City, Calif.), which allows endovascular cardiopulmonary bypass, cardiac venting, aortic occlusion, and cardioplegic arrest for internal thoracic artery–coronary artery anastomoses. Methods: Nineteen dogs had thoracoscopic takedown of either single ( n = 14) or bilateral ( n = 5) internal thoracic arteries followed by minimally invasive coronary bypass with cardioplegic arrest, done by means of the port-access system. The anastomotic technique was modified after the fourth animal by switching from a microscope to a 2.5 cm oval port and performing a conventional anastomosis with operative loupes. The adequacy of delivery of cardioplegic solution, ventricular decompression, and anastomotic patency was assessed. Results: The crossclamp and bypass times were 50 ± 15 minutes and 87 ± 28 minutes (mean ± standard deviation), respectively. The mean myocardial temperature after cardioplegia was 17° ± 1° C and the aortic pressure (–3 ± 9 mm Hg) and pulmonary artery pressure (4 ± 1 mm Hg) were low throughout the procedure. All animals were weaned from bypass without inotropic agents. Angiograms and autopsies demonstrated successful thoracic artery takedown and anastomotic patency in 18 of 19 animals, with 100% anastomotic patency after the technique had been modified after the fourth animal. Conclusion: This study describes a reproducible technique for minimally invasive coronary bypass that allows myocardial protection, anastomotic precision, and predictable thoracic artery graft patency. Clinical trials are indicated(J Thorac Cardiovasc Surg 1997;114:46-52)