Case ReportsAvulsion of the Left Internal Mammary Artery After Minimally Invasive Coronary Bypass
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During minimally invasive coronary artery bypass grafting, great care is taken to ensure adequate length and smooth course of the conduit. The LIMA pedicle is routinely sutured to the epicardium to prevent torsion about the anastomosis. The initial presentation of this patient was ischemia and infarction. We assumed that the LIMA had occluded due to technical problems, such as injury to the artery during dissection, obstruction of the distal anastomosis, or kinking of the graft. The mechanism
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Left anterior descending artery grafting via left anterior small thoracotomy without cardiopulmonary bypass
Ann Thorac Surg
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Cited by (18)
Avulsion of the left internal mammary artery graft after minimally invasive coronary surgery [4] (multiple letters)
2001, Annals of Thoracic SurgerySurgical myocardial revascularization without cardiopulmonary bypass
2000, Annals of Thoracic SurgeryCitation Excerpt :Furthermore, the limited access obtained during minithoracotomy precluded adequate mobilization of LIMA and required lengthening with inferior epigastric artery [3]. Though with improved techniques this is not required [18], midsternotomy always ensures proper length of LIMA which not only improves quality of anastomosis but can also prevent catastrophic complication of LIMA-LAD anastomotic disruption due to short IMA, as has been reported [18, 30]. Incomplete revascularization has been clearly identified as a main contributor to higher hospital mortality and morbidity and early return of angina [22, 33–35].
Con: Beating-heart surgery for coronary revascularization: Is it the most important development since the introduction of the heart-lung machine?
2000, Annals of Thoracic SurgeryCitation Excerpt :In another series [15], a third of the patients had angiographic evidence of graft occlusion within 24 hours after undergoing BHCABG via a minimally invasive incision. McMahon and coauthors observed avulsion of the IMA 5 days after a similar procedure, and other surgeons have had unreported anecdotal instances of this complication [17]. In the early experience of Gundry and associates [18], BHCABG (with a full sternotomy) was considered for all patients in need of myocardial revascularization.
Avulsion of an H graft during closed-chest cardiopulmonary resuscitation after minimally invasive coronary artery bypass graft surgery
2000, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :At the end of the procedure, despite maximal inotropic support and intra-aortic balloon counterpulsation, the patient could not be separated from cardiopulmonary bypass and expired in the operating room. Avulsion of the LIMA graft from the LAD after a LAST procedure, as a result of strenuous physical activity and heavy lifting in the early postoperative period, has been previously reported in the literature by the authors' group.5 As in the case described, the exact mechanism of avulsion of the H graft pedicle remains not entirely understood.
Minimally invasive cardiac surgery: Surgical techniques and anaesthetic management
1999, Annales Francaises d'Anesthesie et de ReanimationOrthotopic cardiac transplantation after minimally invasive direct coronary artery bypass
1999, Journal of Thoracic and Cardiovascular Surgery