Bilateral Internal Thoracic Artery MICS CABG Technique with Double Lung Ventilation (VIDEO)

Background: Multiarterial off-pump coronary bypass surgery through an anterolateral minithoracotomy allows for minimally invasive revascularization (MICS CABG) in patients with coronary multi-vessel disease. The conventional single lung ventilation approach can be limited by a variety of chronic lung diseases, as well as hypoventilation and hypoxemia induced by intrapulmonary shunting, acute lung injury induced by enhanced airway pressure, and pulmonary hypertension induced by hypoxic pulmonary vasoconstriction, particularly in case of bilateral internal thoracic artery (BITA) harvesting.

Method: We present our technique of anaortic off-pump BITA MICS CABG with continuous double lung ventilation. After left anterolateral mini-thoracotomy, lung-retracting pericardial-pleural fan sutures are placed. Both internal thoracic arteries are skeletonized, followed by generation of the bypass anastomoses according to coronary anatomy and pathology.

Results: So far, in 15 patients, the BITA MICS CABG approach with double lung ventilation has been applied. All planned coronary targets could be revascularized under lung-protective biopulmonary ventilation.

Conclusion: The presented technique enables continuous double lung ventilation during complex off-pump MICS CABG procedures. Thereby, inherent issues of single lung ventilation may be avoided, and even patients with impaired pulmonary function can be considered for multi-vessel MICS CABG strategies, particularly in combination with an anaortic BITA approach.

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Artikel online veröffentlicht:
28. Januar 2023