[HSF] RCA osteal lesion-osteal reconstruction

[Mark Levinson]

On Apr 29, 2008, at 12:01 AM, DukeB60 at aol.com wrote:

> Z,
>     Check out the video on the Heart Surgery  Forum website by Mark  
> Levinson.
>  He has some excellent photos and is a  great resource for the  
> technique.  If
> you have the robot it greatly  simplifies taking down one or both  
> IMA's, as
> you well know.
>
>

Subxiphoid OPCAB is safe if you understand the anatomy, technique,  
and add a few instruments
to your tray.

The key is using a double Rultract with a connecting bar to lift the  
lower sternum.   The RIMA can
be harvested in a standard manner, and OPCAB technique to the distal  
RCA is not too difficult.

However, if you have not reviewed the technique before and prepared  
ahead of time for approach, I would
not suggest you try it on this patient.    I can give you more  
information if you are interested.

Myself, in my own practice, I would offer this patient a subxiphoid  
RIMA- (or RGEA) to PDA as a alternative to a DES and lifelong  
Plavix.....

Mark

Mark Levinson, MD.
Founder, Editor-in-Chief
The Heart Surgery Forum®
Multimedia Cardiothoracic Journal
URL: http://www.hsforum.com
URL: http://newoptionsinheartsurgery.com
Emali:  mmlevinson at hsforum.com