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1.
Heart Surg Forum ; 6(1): E10-1, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12611739

RESUMO

INTRODUCTION: Coronary artery bypass grafting without cardiopulmonary bypass (CPB) is now an accepted technique of complete myocardial revascularization. The technique was originally described by Kolesov [Kolesov 1967] and later abandoned when the CPB became the gold standard for cardiac operations on the arrested heart. In the late 1980s off-pump coronary grafting was reintroduced by Benetti and Buffolo with very encouraging results, especially for high-risk patients [Benetti 1985, Buffolo 1996]. This technique was limited to the grafting of left anterior descending (LAD) coronary artery and sometimes to the right coronary artery (RCA) [Benetti 1985, Buffolo 1996]. In recent years, technical advantages in coronary exposure and mechanical stabilization have come from the industry, leading to the possibility of a complete off-pump myocardial revascularization. The exposure of coronary arteries in the circumflex territory has been described by Ricardo Lima from Brazil. He described a series of four sutures on the pericardium, which allowed a good exposure of such surgically difficult territory. Tomas Salerno simplified the "Lima sutures" with a technique using a single suture placed in the oblique sinus of the posterior pericardium, which allowed a good exposure of the circumflex territory and less heart manipulation. [Bergsland 1997, Salerno 1999, Ricci 2000]. This deep pericardial suture may injure the organs situated just behind the pericardium, such as the esophagus and thoracic aorta [Ricci 2000], and several complications have been reported in literature: injury of the left lower pulmonary vein has resulted in post-operative bleeding and dangerous hematoma behind the left atrium [Fukui 2002]; and subcutaneous emphasema has been detected in several cases in our experience. We report a different way to pose the single lima suture in order to avoid any damage to the structures behind the posterior pericardium.


Assuntos
Revascularização Miocárdica/métodos , Técnicas de Sutura , Ponte de Artéria Coronária/métodos , Humanos , Técnicas de Sutura/efeitos adversos
2.
Innovations (Phila) ; 2(4): 205-8, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22437062

RESUMO

PURPOSE: : The saphenous vein is the most commonly used bypass conduit for coronary surgery. Endoscopic harvesting techniques are associated with significant reduction of wound complications but are time-consuming and expensive. The authors developed a device to perform minimally invasive harvesting of the saphenous vein-rapidly, inexpensively, and safely. DESCRIPTION: : Patients hospitalized for isolated CABG (n = 134) participated in the study. Each vein had been harvested through the use of our minimally invasive system. EVALUATION: : The veins were harvested in 130 cases; 378 vein samples were collected for pathology study, with complete integrity of the vein as the result of the "no touch" technique with the device. This integrity could be very important for the long-term patency of the vein graft. After surgery, there were no wound dehiscences, infections, or major hematomas. There was 1 case (0.76%) of superficial hematoma and 3 cases (2.30%) of lymphoceles. CONCLUSIONS: : Although commercial disposable systems are now available to allow minimally invasive harvesting of the saphenous vein, the authors think that harvesting the greater saphenous vein with the cylinder steel device is easy to learn can be used safely and at much-reduced costs.

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