Innovations : technology and techniques in cardiothoracic and vascular surgery
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Innovations (Phila) · Nov 2013
The accuracy of transit time flow measurement in predicting graft patency after coronary artery bypass grafting.
Transit time flow measurement (TTFM) is a method used to assess intraoperative blood flow after vascular anastomoses. Angiography represents the criterion standard for the assessment of graft patency after coronary artery bypass grafting (CABG). The purpose of this study was to compare flow measurements from TTFM to diagnostic angiography. ⋯ Although TTFM can be a useful tool for graft assessment after CABG, false negatives can occur. Angiography remains the criterion standard to assess graft patency and quality of the anastomosis after CABG.
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Innovations (Phila) · Nov 2013
Minimally invasive coronary bypass using internal thoracic arteries via a left minithoracotomy: "the Nambiar Technique".
Harvesting of the right internal thoracic artery (RITA) under direct vision, through a left minithoracotomy, without robotic or thoracoscopic assistance has never been done or described before. Bilateral internal thoracic arteries (BITAs) in coronary artery bypass grafting (CABG) have shown greater survival and freedom from reintervention. The aim was to develop a multivessel minimally invasive CABG technique in which the BITAs are harvested under direct vision and complete revascularization of the myocardium is done by the off-pump method, using only BITAs (left internal thoracic artery [LITA]-RITA Y) through a 2-in left minithoracotomy, without robotic/thoracoscopic assistance-the "Nambiar Technique." ⋯ The Nambiar Technique encompassed using a 2-in left minithoracotomy incision through which the BITAs were conveniently harvested in a skeletonized manner under direct vision without robotic or thoracoscopic assistance. Multivessel total arterial revascularization was then done using the LITA-RITA Y composite conduit by the off-pump methodology. The early outcomes have been excellent, and coronary angiograms showed widely patent grafts. This technique is reproducible and can be done on an empty beating heart to aid in training.