Off-pump complete revascularization through a left lateral thoracotomy (ThoraCAB): the first 200 cases

Wednesday, August 19, 2009 - Off-pump complete revascularization through a left lateral thoracotomy (ThoraCAB): the first 200 cases

Sudhir P. Srivastava, MDa*, Kirit N. Patel, MDa, Rajaratnam Skantharaja, MDa, Reyna Barrera, CSTa, Diana Nanayakkara, CCRNa, Vishwa Srivastava, BSa
a Cardiac Surgical Associates of West Texas, Odessa, Texas, USA

* Address reprint requests to Dr Sudhir P. Srivastava, Cardiac Surgical Associates of West Texas, PA, 419 West 4th, Ste 1000, Odessa, TX79761, USA
Presented at the Video Session of the Forty eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 8 through 10, 2001.

BACKGROUND: Conventional coronary bypass surgery is associated with substantial morbidity caused by cardiopulmonary bypass (CPB) and median sternotomy. This report describes an innovative technique to perform complete revascularization through a lateral thoracotomy without CPB (thoraCAB).

METHODS: From February 2000 to April 2001 a total of 200 patients underwent thoraCAB. The patient is positioned with the left side elevated to 45 degrees. A 5 to 6inch incision is made over the left fourth or fifth intercostal space from just medial to the nipple to the anterior axillary line. The left internal thoracic artery is harvested as a pedicle graft under vision. Proximal anastomoses are first completed on the ascending aorta, followed by the distal coronary anastomoses on the beating heart using a stabilizer. Intercostal nerve freezing is done using a cryoprobe.

RESULTS: Complete revascularization was achieved in all patients. The number of grafts averaged 2.9 1.08 per patient. One patient (0.5%) died of renal failure. Two patients (1%) were converted to CPB. No strokes were observed. Three patients (1.5%) required prolonged ventilation (>48 hours). Five patients (2.5%) had postoperative bleeding requiring reexploration. Of the patients, 16 (8%) developed new-onset postoperative atrial fibrillation.

CONCLUSIONS: ThoraCAB has been feasible in the vast majority of patients requiring coronary bypass surgery. The prevalence of postoperative atrial fibrillation was low. Postoperative pain maybe lessened with intercostal nerve freezing.