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ISMICS 2024 Annual Meeting
29 May - 1 June, 2024 | Athens, Greece
PC.41
Offpump Midcab With Partial Lower Sternotomy - A Less Invasive Approach With A Maximum Exposure
Poster Presenter
Authors
Part of Topic
Coronary Revascularization
ABSTRACT
OFFPUMP MIDCAB WITH PARTIAL LOWER STERNOTOMY; A LESS INVASIVE APPROACH WITH A MAXIMUM EXPOSURE
Anas Ahmad, Mazhar Ur Rehman
INSTITUTION: OMER HOSPITAL & CARDIAC CENTER, LAHORE.
OBJECTIVE: Coronary artery bypass grafting can be done off pump with minimally invasive techniques. Minimally invasive direct coronary artery bypass usually done with left anterior thoracotomy offers limited exposure that only caters LAD lesions. It can be done through partial lower sternotomy that offers good exposure for both left and right-sided lesions. The purpose of this study is to demonstrate the safety and efficacy of this technique.
METHODS: From Jan 2021 – March 2022 a total of 32 patients underwent off pump MIDCAB. Mean age 65+/- 5.3 (59-77) yrs. 9 patients had LAD & Diagonal Disease, 5 only LAD, 14 patients had LAD, Diagonal and RCA disease. 4 patients had LAD, OM & RCA Lesions. Skin incision was given from 4th intercostal space till xiphoid. Partial Lower sternotomy was done till 3rd rib and horizontally divided in L shaped fashion. Pedicled LIMA was harvested using ochsner favaloro’s retractor. Off pump grafting done using suction device (Medtronic octopus). LIMA grafted to LAD and great saphenous vein was used to graft Diagonal and RCA lesions.
RESULTS: No hospital death was reported in MIDCAB cases. Length of incision was 8.47 +/- 1.2cm (range 7.5-10cm), average number of grafts were 2 (1-3), No blood transfusion required, No sternal dehiscence. Patency rate was 96% with no history of postoperative angina. LIMA harvesting and grafting were done with the same ease as with full sternotomy. Smaller skin incision provided improved patient satisfaction and cosmesis. Intact manubriosternal joint provided better sternal stability, less postoperative pain and early mobilization.
CONCLUSSION: Partial lower sternotomy is a less invasive and effective approach for off pump MIDCAB providing surgeon the same amount of ease for harvesting LIMA and grafting left and right sided lesions. It offers better sternal stability and improved cosmesis.