MIDCAB –proximal anastomosis(an enigma)- coronary web mastering a solution

Rajendra Vasaiya, MCh, Vihar Shah,MD, Sunil Vyas,M.sc.PGDPT

BACKGROUND: Distal anastomosis to the coronary arteries may not cause that much problem due to relatively easy accessibility. Method of Exposing aorta and if due to anatomical and hemodynamic limitation aorta can not be expose what other alternatives site are available is explained.


METHOD: once coronary artery is exposed and stabilized distal anastomosis is a relatively easy task. When question of proximal anastomosis arises, through minithoracotomy(from 4th ICS) , where is the aorta? Aorta is no where in the picture. Due to our traditional mind set we look forward to proximal ascending aorta for proximal anastomosis. Technique of exposing proximal ascending aorta is explained. What are the other alternative site and how to carry out proximal anastomosis with alternative site is also explained. A new concept called coronary web mastering along with arterial loop technique is also shown in detailed.

REASULT: with different technique explained above, we have complete and satisfactory proximal anastomosis. Because of not finding suitable site for proximal anastomosis we have never converted our MIDCAB procedure to conventional sternotomy procedure

CONCLUSION: In MIDCAB CABG proximal anastomosis are real challenging compare to distal anastomosis. Over the last 10 yrs we have gradually evolved various alternative site for proximal anastomosis . Though technically challenging these methods are effective for complete triple vessel revascularization through sternal sparing minimally invasive minithoracotomy approach.