• Images in cardiology

A 65 year old man with symptoms of myocardial ischaemia and positive exercise tolerance test underwent coronary angiography, which demonstrated an occluded left anterior descending artery (LAD) (arrowhead in panel A), and unobstructed circumflex and right coronary artery.

In view of the unsuited anatomy for percutaneous revascularisation, the patient underwent a minimal invasive direct coronary artery bypass graft of the left internal mammary artery (LIMA) to LAD. The operation was performed via a 5 cm skin incision over the left fourth intercostal space. The anastomosis was performed using a novel magnetic coupling device (Magnetic Vascular Positioner (MVP Series 6000) Ventrica, Fremont, California, USA). The device comprises two magnetic clips sets, which were placed at the standard longitudinal arteriotomies of the LIMA and LAD, respectively. Each clip set consists of three magnetic clips; one clip was positioned at the intravascular surface of the vessel and the other two lied extravascularly. The LIMA-LAD anastomosis is a result of the magnetic field of the two clip sets. Distal vessel preparation and device deployment duration were 95 seconds (LIMA) and 125 seconds (LAD), respectively.

The patient had an uncomplicated recovery and was electively kept in hospital until day 5 postoperatively in order to perform a check angiogram which showed good anastomosis and good distal LAD perfusion (arrowhead in panel B).

This case illustrates a successful and efficient use of this novel magnetic coupling anastomotic device during minimal invasive coronary revascularisation surgery.