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@#Objective To introduce the method and preliminary experience of robot-assisted bilateral internal mammary arteries (BIMA) harvesting for off-pump coronary artery bypass grafting (OPCAB) with 5 grafts via left anterolateral minithoracotomy. Methods BIMA were harvested using the da Vinci robotic surgical system, and the right internal mammary artery (RIMA) was pulled out of the thoracic cavity through right second intercostal space. Intercepting the distal part of the RIMA for the BIMA composite Lima-Rima Y graft and anastomosing the great saphenous vein with remaining RIMA end to end. The Y graft anastomosed with left anterior descending (LAD) branch and diagonal branches (DIAG), artery-vein graft sequentially anastomosed with blunt round branch, left ventricular posterior branch and posterior descending branch. Results The operation succeeded without hemodynamic instability and intra aortic balloon pump (IABP) implantation or cardiopulmonary bypass. The blood flow of Y graft was 24 mL/min, and the blood flow of artery-vein graft was 30 mL/min. Ventilator assistance time was 35 hours, ICU staying time was 62 hours, and postoperative myocardial enzymes increased temporarily. Postoperative coronary CTA showed that all the grafts were patency, and cardiac ultrasound indicated that the heart function was normal. The patient cured and discharged from hospital 7 days after operation. Conclusion Robot-assisted bilateral internal mammary artery harvesting for OPCAB with 5 grafts via left anterolateral minithoracotomy is feasible, which can achieve complete revascularization.
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Objective To evaluate the minimally invasive techniques and myocardial protective results of open heart surgery in beating heart.Methods 138 patients underwent minimally invasive open heart surgery in beating heart under cardiopulmonary bypass (CPB) with light hypothermia,of which 58 cases underwent right anterolateral thoracotomy,35 cases had lower sternotomy and full length sternotomy was performed in 45 cases.Among 138 cases,97 cases had repairment of atrial and ventricular septal defects,8 atrioventricularis communis,18 other congenital heart disease,two left atrial myxomas,one mitral valvuloplasty and 12 mitral value replacement.Results There were no severe arrhythmia and air embolism,but only one operative death because of low cardiac output.Other patients were discharged and had no late deaths.Conclusion Minimally invasive open heart operation in beating heart is a feasible,safe and effective technique for most of the cardiac surgery.Advantages of a right anterolateral thoracotomy or lower hemisternotomy in beating heart are obvious,including a smaller incision,less injury and blood loss,quick recovery,maintenance of the integrity of the bony cage and excellent myocardial protection.It is consistent with the idea of minimally invasive surgery.