[HSF] RE: Left lateral thoracotomy for CABG

[erdinç naseri]

Mark,
what type of retractor do you use for subxyphoid approach and where  are the exact ends of the incision.
erdinc> From: mmlevinson at hsforum.com> Subject: Re: [HSF] RE: Left lateral thoracotomy for CABG> Date: Wed, 16 May 2007 21:52:28 -0500> To: OpenHeart-L at lists.hsforum.com> CC: > > > On May 16, 2007, at 1:05 PM, <ebender001 at charter.net> > <ebender001 at charter.net> wrote:> > > Our fearless leader, Mark Levinson, has been expounding a > > subxyphoid approach, and this may make more sense. Any comments, > > Mark?> > Ed:> First, let me set the record straight. I am *not* fearless. > Especially when doing subxiphoid cases!> > Second, I have now completed 25 subxiphoids, all with arterial > conduits only.> The approach is, at times very elegant. But it can also be time > consuming.> > The results, however, have been excellent. And yes, I have been > measuring> the incisions and they are all exactly the same length. They are > the width> of the palm of my hand (10 cm). This length of incision I found > allows me just enough> room to tie the 7-0 with my fingers, allowing me tactile feed back. > But the> incision also does not involve a thoracotomy, a sternotomy, or any > muscle> rib, nerve, tendon, joint injury.> > As for redo's, I am just now getting enough experience to perform > subxiphoid> in a redo. My first successful case was better than I > expected. He was 84 years old> and prior recipient of a bioprosthetic AVR and vein to RCA two years > agi. He presented> again with chest pain and now had a left main. I performed a > subxiphoid CABG x 2 with> an arterial Y graft to LAD and OM1. He was home in 4 days with no > complications at all.> > My opinion about subxiphoid redo CABG is similar to Hals comments > about mini or> robotic mitrals. Walk before you run (or did he say crawl before > walking...same thing).> Redos are not to be done until after gaining considerable experience > with non-redo subxiphoids.> > However....my brief experience indicates that this approach will > eventually be better for redos> than a left lateral thoracotomy. The descending aorta in such > patients is usually very> athersclerotic. Reaching the PDA can be difficult through a left > thoracotomy. The RIMA> is out of the picture.> > With subxiphoid, I can still have all my options and plus easy > conversion to sternotomy, if needed.> In fact, once the sternum is lifted to dissect the heart and IMAs, > the retrosternal space is now open> and a saw can be passed safely at any time, if needed.> > So far, in 37 total subxiphoid attempts, I have converted 12 cases > (but only 5 of last 21 attempts).> Interestingly, the converted patients still went home with total > arterial reconstructions (except for 1 patient)> and their incisions looked no different than if I had started out > doing a conventional case.> > The 25 successful cases went home with a 10 cm vertical midline > epigastric incision.> > This is still a work in progress, but very feasible in some cases.> > Mark> > Mark M. Levinson, MD> Founder, Editor-in-Chief,> The Heart Surgery Forum> WWW: <http://www.hsforum.com>> Email: <mmLevinson at hsforum.com>> > > > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------