Atsushi Kurata

Minimally Invasive Coronary Artery Bypass Grating Using Bilateral In Situ Internal Thoracic Arteries

When performing minimally invasive coronary artery bypass grafting (MICS CABG), it is difficult to access the right internal thoracic artery (ITA) under direct vision. We successfully performed off-pump MICS CABG using the bilateral in situ ITAs through a 8-cm left thoracotomy under direct vision for a 76-year-old man. His postoperative course was uneventful and all the grafts were patent. This novel, minimally invasive approach safely preserves the sternum and delivers the benefits of bilateral in situ ITA grafting, providing an alternative to conventional CABG and off-pump CABG.

Off-pump minimally invasive coronary artery bypass grafting using the bilateral internal thoracic arteries and the right gastroepiproic artery

We report our initial experience of an off-pump total arterial minimally invasive coronary arterial bypass grafting (MICS CABG) with the use of bilateral internal thoracic arteries (BITA) and the right gastroepiproic artery. A 47-year old male with renal dysfunction secondary to diabetes mellitus was admitted for heart failure due to severe triple-vessel disease. Off-pump MICS CABG with total arterial grafts was elected because the patient refused to undergo median sternotomy due to the strong desire to regain the baseline function promptly. Total arterial grafts were selected to maximize the potential long-term outcome. There were no postoperative complications except temporary dialysis. Postoperative coronary computed tomography revealed the patency of all grafts. Our experience suggests that BITA can be safely harvested under direct vision in MICS CABG. Total arterial graft revascularization with BITA via minimally invasive approach may offer the benefits of MICS CABG while providing the undetermined but potentially superior conduit longevity of arterial grafts.

Protection of the spinal cord with pentobarbital and hypothermia

BACKGROUND Ischemic spinal cord damage during thoracic aortic operations has not been eliminated despite application of various adjuncts. We experimentally investigated the protective effects of pentobarbital and hypothermia on the spinal cord subjected to ischemia. METHODS Among nine groups of 6 rabbits each, groups AI to AIII underwent 20-minute infrarenal aortic occlusion, and groups BI to BVI underwent 40-minute occlusion. Five milligrams per kilogram of pentobarbital was administered to groups AII and BII; 10 mg/kg in groups AIII, BIII, and BVI; 20 mg/kg in group BIV; and none in groups AI, BI, and BV. In groups BV and BVI, hypothermia was induced. Forty-eight hours postoperatively, the motor function of the lower limbs was evaluated. RESULTS Statistically significant recovery of motor function was observed in animals in groups AII, AIII, BIII, BIV, BV, and BVI. CONCLUSIONS Pentobarbital showed dose-dependent protective effects of the spinal cord. Moderate hypothermia alone also showed protective effects. Combined use of pentobarbital and hypothermia resulted in highly significant recovery of spinal cord function.

Perioperative outcomes of off-pump minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries under direct vision†

OBJECTIVES We previously introduced techniques to harvest and use the right internal thoracic artery in minimally invasive coronary artery bypass grafting (CABG) via a single left thoracotomy for revascularization with bilateral internal thoracic arteries (BITA). We report our short-term outcomes of patients who underwent minimally invasive CABG using BITA and a single internal thoracic artery (SITA). METHODS Consecutive patients who underwent minimally invasive CABG using BITA or SITA at a Japanese medical center between February 2012 and December 2015 were reviewed retrospectively. Preoperative, intraoperative and 30-day postoperative outcomes were analysed. Perioperative data for the SITA cohort is presented to provide a context in which the outcomes of the BITA cohort can be evaluated. RESULTS A total of 25 and 37 patients underwent BITA and SITA revascularization, respectively. The mean duration of the operation was longer in the BITA group than in the SITA group (265 ± 104 vs 336 ± 73 min). There were no deaths in the BITA group and one death in the SITA group. There were no strokes in either cohort, and new haemodialysis was required in one patient in each group. All BITA grafts were harvested without major complications and were all patent on computed tomography angiograms 1 week following the operations. CONCLUSIONS BITA can be safely harvested in a reproducible manner under direct vision via a small left thoracotomy. The potential advantages of minimally invasive CABG using BITA, although yet to be established, include a long-term survival benefit conferred by BITA grafts and elimination of the risk of sternal wound infection, in addition to the established advantages of minimally invasive coronary artery surgery. This approach has the potential for further optimization with hybrid revascularization strategies.

Side-to-Side Anastomosis in Off-Pump Coronary Artery Bypass Grafting:

A technique is described for side-to-side anastomosis as a functional end-to-side anastomosis, in which no direct contact with the vessel walls by surgical instruments is required during suturing, thus avoiding the possibility of damage to the graft.

Minimally invasive coronary artery bypass grafting for the left anterior descending coronary artery.

OBJECTIVE A single surgeon conducted One hundred and twelve patients underwent minimally invasive direct coronary artery bypass grafting for the left anterior descending coronary artery 112 patients at Yamato Seiwa Hospital from September 1996 until August 1999. METHODS All procedures were performed via left anterior short thoracotomy using a stabilizer during graft anastomosis. RESULTS No operative deaths occurred but 3 patients died while hospitalized due to noncardiac events. Graft occlusion was seen in 3 patients early postoperatively. Other angiography graft failure such as stenosis was seen in 11 patients. Occlusive lesions of other coronary arteries occurred in 77 patients (69%) and 53 patients underwent percutaneous transluminal coronary angioplasty the pre/postoperatively for those lesions. CONCLUSIONS These results suggest that minimally invasive direct coronary artery bypass grafting is seen by cardiologists as a reasonable form of revascularization in conditioned patients having left anterior descending artery lesion, and that minimally invasive direct coronary artery bypass grafting has a spectrum of candidates different from that of conventional surgical revascularization for the coronary artery.

Aortic penetration with sudden onset of dyspnea

A previously healthy 53-year-old man was transferred with sudden onset of dyspnea. A continuous murmur was heard at the 3rd left sternum border. Chest radiography showed pulmonary congestion. Transthoracic echocardiography revealed shunt flow from the ascending aorta to the pulmonary artery (Figure 1). Right ventricular systolic pressure was elevated to 50mm Hg. Contrast-enhanced computed tomography showed an ascending aortic aneurysm protruding into the pulmonary artery, with shunt flow from the tip of the aneurysm (Figure 2). The diagnosis was congestive heart failure and pulmonary hypertension secondary to ascending aortic aneurysm penetrating the main Asian Cardiovascular & Thoracic Annals 2017, Vol. 25(1) 78–79 The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492315594547 aan.sagepub.com

Spasms of coronary artery immediately after off-pump bypass grafting.

A 70-year-old lady underwent successful off-pump coronary artery grafting of the left internal thoracic artery to the left anterior descending artery (LAD). On transfer to the intensive care unit, an electrocardiogram showed ST-segment depression in leads V5 and V6. Ultrasound examination showed very little diastolic blood flow in the arterial conduit, suggesting little flow to the LAD. Angiography showed narrowing of several sections of the LAD, despite a satisfactory appearance of the graft and anastomotic site (Figure 1A). Spasms of the LAD were diagnosed, and diltiazem infusion (1.0mg min 1 kg ) was started. The electrocardiogram normalized 7 h later. Ultrasound findings 5 days later showed improved graft flow. An angiogram 7 days postoperatively revealed normal flow in the LAD (Figure 1B). Spasms of the LAD after grafting have seldom been shown angiographically.

Simplified physiological pacing after cardiac surgery.

Temporary pacing wires are routinely placed at the end of cardiac surgery. These pacing wires are helpful in maintaining patients with postoperative bradycardias, and physiological pacing is also more desirable in critically ill patients. We herein report our simplified procedure for atrial pacing. This technique uses commercially available intravenous pacing catheters. The catheter is passed through the skin, and its tip is placed at the pericardial oblique sinus just between the right and left pulmonary veins. Atrial pacing is then initiated with a temporary pulse generator. This procedure is simple and effective for patients undergoing cardiac surgery. We also report two clinical cases that satisfactorily underwent atrial pacing using this procedure.