Interactive Cardiovascular and Thoracic Surgery 2:181-182(2003)
© 2003 European Association of Cardio-Thoracic Surgery
Work in progress report - Coronary |
Skeletonized arterial graft holder for coronary artery bypass grafting
Hiroyuki Kamiyaa,*,
Teruaki Ushijimaa,
Chikako Ikedaa and
Go Watanabeb
a Department of Cardiovascular Surgery, Maizuru Mutual Hospital, Hama 1035, Maizudu 625-8585, Japan
b Department of General and Cardiothoracic Surgery, Kanazawa University Hospital, Takaramachi 13-1, Kanazawa 920-8641, Japan
* Corresponding author. Tel.: +81-773-622-510; fax: +81-773-644-301
h.kaiya{at}triton.ocn.ne.jp
Received October 29, 2002;
received in revised form January 19, 2003;
accepted January 22, 2003
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Abstract
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A skeletonized arterial graft holder, designed for use during off-pump coronary artery bypass grafting, is described. This new holder is atraumatic and holds a skeletonized arterial graft securely during anastomosis. It helps the operator to make the first several stitches avoiding graft injuries, and the use of this instrument facilitates the use of skeletonized arterial grafts for coronary artery bypass grafting.
Key Words: Skeletonized arterial graft holder; Coronary artery bypass grafting; Off-pump coronary artery bypass
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1. Introduction
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The skeletonization technique for arterial conduits including the internal thoracic artery, the radial artery, and the right gastroepiploic artery has become popular for coronary artery bypass grafting [1–3]. Skeletonization of the arterial conduits increases the effective length and free flow of the grafts, and it facilitates complete arterial revascularization [4]. However, considerable dexterity is required in coronary anastomosis using skeletonized arterial grafts. There is no surrounding tissue around the skeletonized grafts and the grafts have to be held directly by the forceps, potentially causing endothelial injury. In this report, we described a new instrument, the skeletonized arterial graft holder, that securely holds the grafts while avoiding graft injury.
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2. Technique
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The skeletonized arterial graft holder consists of a rubber component which holds the graft conduit (Fig. 1) and a clip with multiple curving handle which grasps the rubber component (Fig. 2). The rubber component consists of a hollow body and a flap, and the skeletonized arterial graft is placed between them and locked by the clip. Then, the graft is properly trimmed and the graft holder is positioned adjacent to the coronary arteriotomy (Fig. 3).
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Fig. 1 The rubber part of the skeletonized graft holder, which consists of a hollowed body and a thin flap.
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Fig. 2 The rubber part is locked by the clip with multiple curving handle. The rubber flap is very soft, so it may not cause endothelial injury of the grafts.
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In our institute, distal anastomosis is started at the heel using double-armed 8-0 polypropylene suture. A continuous row of loose sutures is placed on each side of the anastomosis. After the graft is approximated and both ends of the suture are pulled tight, the skeletonized arterial graft holder is released. The anastomosis is then completed.
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3. Initial experience
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From June, 2002, we performed 20 cases of coronary artery bypass grafting including 15 off-pump cases and five cases using cardiopulmonary bypass with cardioplegic arrest. In all cases, the left internal thoracic artery was skeletonized and anastomosed to the left anterior descending artery using the skeletonized arterual graft holder. No hospital death and serious complications were observed in this series. The postoperative angiography about 1 month after the operation was performed in all cases, and graft patency was 100%.
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4. Comment
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We previously devised an internal thoracic artery holder, which was designed to facilitate pedicled arterial conduit for coronary artery bypass grafting [5]. This holder had been routinely used with excellent results [6], however, a new device has been required as adoption of the skeletonization technique. The new holder described in the present report enables the surgeon to hold the skeletonized arterial grafts gently without fear of endothelial injury. This holder is especially useful in off-pump coronary artery bypass grafting because the graft is stabilized regardless of the heart beat.
doi:10.1016/S1569-9293(03)00013-6
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References
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Abstract
1. Introduction