Title : Historical evolution from OPCAB to MIDCAB to mini OPCAB surgical technique and results
Abstract:
Between 1970 and 1980 there were experiences and series of patients operated on Direct Coronary Surgery without the use of extracorporeal circulation. During the 80 and 90 the Technique was developed. The MIDCAB was the one that promoted the development of Coronary Surgery without Extracorporeal Circulation and the creation of the initial technology for the posterior universalization of the OPCAB Technique. Today is a standard operation all over the world with thousands of patients done every day In October 1997, using 3D Video we performed the first Ambulatory Coronary Surgery in the World; we call this technique the Xiphoid Approach Because in most patients we must open the lower part of the sternum to be able to perform the operation, we call it the MINI OPCAB Technique Surgical Technique.
The patient is prepared for standard coronary bypass operation through sternotomy The sternum is opened to the 3 o 4 intercostal space depending on the anatomy A Retractor is put in place, the patient is heparinized as a normal OPCAB patient 3mg/KG The left arm of the retractor is elevated; the left mammary is dissected around 8 cm and isolated without the veins Importantly, the angle of the superior part where the mammary is attached to the sternum, needs to be below 20% to avoid any potential kinking In a case of multiple vessels the right side of the retractor is elevated and the left arm put in a normal position and the right mammary artery is dissected the longitude depends of the numbers of grafts and localization to be performed is the right is use as inflow to a vein or a radial artery to perform the distals anastomosis, or the entire right mammary alone.
Results: The mortality was 0%.70 Patients receive anastomoses of the LITA to LAD (100%) and 8 multiples grafts with an average of 2, 2 grafts per patient.
Conclusion: More experience is needed and new and better Technology to spread this Technique worldwide.
