Multivessel, All-Arterial, Off-Pump Surgical Revascularization Without Disruption of the Thoracic Skeleton

Purpose To evaluate the feasibility of performing multivessel off-pump surgical revascularization without manipulation of the thoracic cage. Description The technique consists of bilateral thoracoscopic internal mammary artery harvesting followed by a nonrib-spreading, muscle-sparing opening in the soft tissue of the thorax. An endoscopic cardiac positioner and stabilizers exposes and steadies the target arteries beneath a small opening. Anastomoses are constructed off-pump through the natural width of the intercostal space without the need for rib spreading. Evaluation Fifty-two patients underwent all-arterial, off-pump revascularization through incisions avoiding manipulation of the thoracic skeleton. The mean number of grafts per patient was 2.2 ± 0.4. Transit time flow measurements verified graft patency before closure in all cases. The mean operating time was 4.4 hours (range, 3.4 to 5.6). Hospital length of stay was 2.6 ± 1.9 days. There was no early or late mortality. Postoperative angiography performed in 63.8% of the grafts (74 of 116) revealed an overall patency rate of 98.6%. Conclusions A grafting approach that avoids any manipulation of the thoracic skeleton offers significant patient value and may not be limited to single-graft cases.