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Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery:
doi: 10.1097/IMI.0b013e3181a34740
How-To-Do-It

Tissue Stabilizer Reverse Mounting in Minimally Invasive Direct Coronary Artery Bypass, a Simple Tool in Difficult Times

Mourad, Faisal MRCS; Duncan, Andrew J. FRCS

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From the Cardiothoracic Department, Lancashire Cardiac Centre, Blackpool Victoria Hospital, NHS Foundation Trust, Blackpool, UK.

Accepted for publication February 22, 2009.

Address correspondence and reprint requests to Mr. Faisal Mourad, Cardiothoracic Department, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Rd., Blackpool FY3 8NR, UK. E-mail: dr.mourad@bfwhospitals.nhs.uk and faisalmourad@hotmail.com.

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Abstract

The simple reverse mounting of an Octopus arm over a rib retractor can give more arm length by up to 5 cm inside the chest cavity which could prove to be very useful in patients with huge chest cavities, i.e. chronic obstructive pulmonary disease, high body mass index, allowing more flexibility and better maneuverability of the stabilizer arm during MIDCAB.

A case of a 60-year-old man having a body mass index (BMI) of 40 is presented. His medical history included chronic obstructive pulmonary disease (COPD). He had a tight left main disease. He had a coronary artery bypass grafts 2 years ago with left internal mammary artery to left anterior descending artery and saphenous vein graft to intermediate artery. He came back with increasing angina Canadian cardiovascular score class 3, and a repeat angiogram revealed patent previously mentioned grafts and a proximal obtuse marginal (OM 1) tight lesion that has not been grafted before. We decided to offer him a saphenous vein graft to OM 1 using minimally invasive direct coronary artery bypass through a left thoracotomy. Because of his high BMI and COPD condition it was technically challenging to get the MEDTRONIC Octopus 4 to reach down to the lateral wall of the ventricle (Fig. 1). We managed to mount the tissue stabilizer inversely over the retractor, which gave us an extra 5 cm of the stabilizer’s arm inside the chest cavity, helping us perform the procedure smoothly. The patient had a smooth postoperative recovery. He was discharged home in a stable condition on the sixth day postoperatively as per unit protocol.

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We believe that by adopting this simple technique one can get more length of the stabilizer inside the chest cavity especially in patients with huge chest cavities ie, COPD or high BMI, thus, allowing more flexibility and a better maneuverability of the stabilizer arm. We succeeded in doing a potentially hazardous procedure redo coronary artery bypass grafts through a small lateral thoracotomy in a risky patient avoiding a formal sternotomy with all its hazards and complications, mainly injuring the grafts during the sternotomy.

© 2009 Lippincott Williams & Wilkins, Inc.

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