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Editorial
. 2021 Oct 4:10:140-148.
doi: 10.1016/j.xjtc.2021.09.050. eCollection 2021 Dec.

Total-arterial, anaortic, off-pump coronary artery surgery: Why, when, and how

Michael P Vallely  1 , Michael Seco  2 , Fabio Ramponi  3 , John D Puskas  4
Affiliations
Editorial

Total-arterial, anaortic, off-pump coronary artery surgery: Why, when, and how

Michael P Vallely et al. JTCVS Tech. .
No abstract available

Keywords: anaortic; aorta no-touch; arterial graft; coronary bypass; internal thoracic artery; neurologic injury; off-pump; radial artery; stroke.

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Figures

None
Complete revascularization with arterial conduits, 2 inflows, and no aortic manipulation.
Figure 1
Figure 1
Forest plots of (A) stroke, (B) mortality, (C) myocardial infarction, (D) renal failure, (E) bleeding complications, and (F) atrial fibrillation after CABG with and without manipulation of the aorta.HS, Heartstring “clampless” proximal anastomosis device; PC, partial clamp.
Figure 2
Figure 2
2018 European Society of Cardiology/European Association for Cardiothoracic Surgery Coronary Revascularization Guideline recommendations for specific surgical techniques.
Figure 3
Figure 3
Stepwise approaches to developing advanced coronary surgery programs culminating in anaortic off-pump CABG.,
Video 1
Video 1
Total-arterial, anaortic, OPCAB technique. Components demonstrated: fully skeletonized ITA harvest, retrothymic tunnel formation, pericardial release incisions, RITA-Radial end-to-end extension anastomosis, pericardial “heart string” insertion, passing RITA-Radial extension graft through transverse sinus, high lateral wall sequential anastomosis, inferior wall anastomosis, anterior wall anastomosis, intracoronary shunt insertion, and transit-time flow measurement. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00682-9/fulltext.
Figure 4
Figure 4
Grafting strategies to maintain an anaortic off-pump technique, using multiple-arterial conduits. A, In situ LITA-LAD and in situ RITA-radial extension-lateral/inferior walls. B, In situ LITA-LAD and LITA-RITA (pictured) or LITA-radial “T” graft-lateral/inferior walls. C, In situ RITA-LAD and in situ LITA-lateral wall. D, In situ LITA-LAD, LITA-Radial “Y” graft-diagonal vessel, and RITA-lateral wall.
Figure 5
Figure 5
Intracoronary silastic shunts: preparation (A) and insertion (B).
See this image and copyright information in PMC

Comment in

References

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