Source: https://patents.google.com/patent/US5888247?oq=5%2C666%2C293
Timestamp: 2018-05-25 16:37:55
Document Index: 342793738

Matched Legal Cases: ['art 16', 'art.\n4', 'art,\n16', 'art 2', 'art 2', 'art 2', 'art 2']

US5888247A - Method for coronary artery bypass - Google Patents
US5888247A
US5888247A US08419991 US41999195A US5888247A US 5888247 A US5888247 A US 5888247A US 08419991 US08419991 US 08419991 US 41999195 A US41999195 A US 41999195A US 5888247 A US5888247 A US 5888247A
US08419991
Frederico J. Benetti
The invention comprises a method for performing a coronary artery bypass graft on a beating heart under thoracoscopic visualization without opening the chest wall. At least one small opening is formed in the patient's chest, a target artery for an arterial blood supply is located, instruments are introduced through one or more small openings formed in the patient's chest to prepare the target artery for fluid connection to the coronary artery, and instruments are introduced through one or more small openings formed in the patient's chest to connect the target artery to the coronary artery distal from a stenosis. In a preferred embodiment, a minimal left anterior intercostal thoracotomy provides access to form an anastomosis between the left internal mammary artery (LIMA) and the left anterior descending artery (LAD) while thoracoscopic viewing facilitates harvesting the LIMA. In other embodiments, access to the patient's heart may be obtained through a trocar sheath or other means for providing percutaneous access to the patient's thoracic cavity without opening the chest-wall. Thoracoscopic visualization, depending on the procedure, is used to locate the arterial blood supply, the location of the coronary artery to be bypassed and the location of the occlusion in the artery. In other embodiments, the diagonal (Dx) or circumflex (Cx) arteries may be bypassed.
A coronary artery bypass graft (CABG) involves performing an anastomosis on a diseased coronary artery to reestablish blood flow to an ischemic portion of the heart muscle. Improved long-term survival has been demonstrated bypassing the left anterior descending artery (LAD) with a left internal mammary artery (LIMA). Loop, F. D., Lytle, B. W., Cosgrove, D. M., et al. "Influence of the Internal Mammary Artery on 10 Years Survival and Other Cardiac Events," N. Eng. J. Med., 1986; 314:1-6. This has encouraged surgeons to extend revascularization with arterial grafts to all coronary arteries. In multiple-vessel disease, other arteries have then to be used, such as: the right internal mammary artery (RIMA), the right gastroepiploic artery, the inferior epigastric artery and the radial artery. At the same time, other techniques are also being used: arterial sequential anastomosis and/or graft elongated and/or Y-or T-grafts. Calafiore, A. M., DiGianmarco, G., Luciani, N., et al. "Composite Arterial Conduits for a Wider Arterial Myocardial Revascularization." Ann Thorac. Surg., 1994:58:185-191 and Tector, A. J., Amundson, S., Schmahl, T. M., et al. "Total Revasculization With T-Grafts". Ann Thorac. Surg., 1994:57:33-39.
For these and other reasons, providing an anastomosis between an internal mammary artery and the LAD may be the best therapeutic option for severe proximal lesions. Benetti, F. J., Rizzardi, J. L., Naselli, G., et al., "Anastomosis Manerio Coronaria Sin Circulation Extracorporea," Prense Medica Argentina, 1985; 73:213. Accordingly, there is a need for improved CABG procedures that simplify surgical techniques and diminish hospital stays and costs.
To prevent excess bleeding and to partially stabilize the vessel, a segment of LAD 26 is occluded with ligating stay sutures comprising 2.5 cm lengths of 5/0 polypropylene 28 or other appropriate ligature material as shown in FIG. 5. Applying tension to the ligatures 28 helps stabilize LAD 26 even though heart 16 is beating. Other conventional means for occluding and stabilizing the artery may be suitable. Forceps 30 are introduced through thoracotomy 10 to further stabilize and retract LAD 26. Scalpel 32 is then introduced to form arteriotomy 34 in LAD 26. As shown in FIGS. 6-10, the anastomosis between LIMA 22 and LAD 26 is formed by suturing with 7/0 polypropylene 36 and needle 38 manipulated by forceps 40. Other conventional means may be used as well. Preferably, the anastomosis is formed with a continuous suture and the aid of a conventional blower device (not shown). Further details of the blower are discussed in Tech K. H. T., Panos, A. L., Harmantas, A. A., et al. "Optimal Visualization of Coronary Artery Anastomosis by Gas Jet," Ann. Thorac. Surg., 1991.
Upon completion of the anastomosis, the anticoagulant is reversed by suitable means such as protamine. The hemostasis should be carefully controlled. The thoracotomy is closed in by conventional means; the surgery does not require resection of the costal cartilage. If the pleura is closed, a small tube for drainage may be left in place and removed the same day as surgery. If the pleura is open, a larger tube should be left in place for 24 hours. All drainage tubes are introduced through the small incision for the thoracoscope.
FIG. 11 shows a series of trocars 42, 44, 46, 48 and 50 useful in the practice of the invention. In this embodiment, a thoracotomy is not necessary. Instruments 52 and 54 are introduced through the trocars to perform the dissection of the LIMA, the arteriotomy of the LAD and the formation of the anastomosis. Instruments 52 and 54 are conventional and include electrosurgical tools, graspers, forceps, scalpels, electrocauteries, clip appliers, scissors, etc. Although the trocars shown are introduced through the intercostal spaces, other points of access to the thorax may be suitable, such as parasternal punctures, midclavicular line punctures and a subxyphoid puncture.
Mortality, morbidity and perioperative myocardial infarction have been 0%. Six patients were extubated at the operating room. In 5, the pleura was maintained closed. Two patients were discharged from hospital 24 to 36 hours post-surgery; six patients were discharged between 36 and 72 hours; the other 2 were discharged 5 and 6 days post-surgery due to longer recovery time (both were patients with previous acute myocardial infarcts.) No blood transfusions were required. A new coronary angiography was done in 4 patients to monitor the patency of the grafts. Patency of the mammary artery graft was 100% when the patient was restudied before hospital discharge.
The drawings and examples are primarily directed to a graft involving the LIMA and the LAD, the Dx and the Cx arteries; nevertheless, this invention is suitable for many other graft possibilities. For example, other coronary arteries that may be bypassed include the obtuse marginal, the ramus intermedius, the right coronary, the posterior descending and others. Arteries other than the LIMA may be used to provide the arterial blood supply, such as the right internal mammary artery, the gastroepiploic artery and other arteries. Using a free graft shunt using a harvested vein or artery or a synthetic graft to form anastomoses between the aorta and the target coronary artery is also possible. Although intercostal thoracotomies are described to provide access to the heart, in some situations it may be desirable to remove a portion of a rib to improve access.
Additionally, the methods of this invention can also be practiced with the use of extracorporeal circulation, making a femoro-femoral cannulation (even percutaneously) to assist the patient for a few minutes during the anastomosis. These and other modifications that would be apparent to one skilled in the art are within the scope of this invention, which is to be limited only by the claims.
1. A method for performing a coronary artery bypass graft procedure on the beating heart of a human patient comprising:
2. The method of claim 1 wherein the thoracotomy is a minimal thoracotomy having a size of incision which is not substantially greater than 12 cm.
3. The method of claim 1 or 2 further comprising the step of stabilizing said beating heart.
4. The method of claim 3 wherein said coronary artery of said beating heart is stabilized by a method selected from the group consisting of contacting tissue proximate to said artery with forcep means, and tensioning ligatures about said coronary artery.
5. The method of claim 3 wherein said beating heart is stabilized by forcep means engaging tissue proximate to said coronary artery on either side of said arteriotomy.
6. The method of claim 1 wherein said coronary artery is selected from the group consisting of the left anterior descending, diagonal, circumflex, obtuse marginal, ramus intermedius, right coronary and posterior descending artery.
7. The method of claim 1 wherein said target artery is selected from the group consisting of the gastroepiploic artery, the right internal mammary artery, and the left internal mammary artery.
8. The method of claim 7 further comprising the step of separating said target artery from its support using instruments introduced through said thoracotomy.
9. The method of claim 7 further comprising the step of separating said target artery from its support, wherein said separation is visualized by a thoracoscope.
10. The method of claim 2 wherein said minimal thoracotomy is intercostal and in the left anterior chest, and wherein said target artery is the left internal mammary artery and said coronary artery is selected from the group consisting of the left anterior descending artery, a diagonal artery, and the circumflex artery.
11. The method of claim 1 wherein the formation of said arteriotomy is visualized by a thoracoscope.
12. The method of claim 1 wherein completion of said anastomosis is visualized by a thoracoscope.
13. The method of claim 1 wherein said anastomosis is completed using a graft selected from the group consisting of a harvested artery, a harvested vein, and a synthetic graft.
14. The method of claim 1 wherein said anastomosis is between the aorta and said coronary artery and is completed using a graft selected from the group consisting of a harvested artery, a harvested vein, and a synthetic graft.
15. A method for performing a coronary artery bypass graft procedure on the beating heart of a human patient comprising:
forming an intercostal minimal thoracotomy in the left anterior chest of the human patient to provide access to the left internal mammary artery and a coronary artery selected from the group consisting of the left anterior descending artery, a diagonal artery, and the circumflex artery of the beating heart,
16. The method of claim 15 wherein said intercostal minimal thoracotomy has a size of incision which is not substantially greater than 12 cm.
17. The method of claim 15 wherein said coronary artery of said beating heart is stabilized by a method selected from the group consisting of contacting tissue proximate to said coronary artery with forcep means, and tensioning ligatures about said coronary artery.
18. The method of claim 15 wherein said beating heart is stabilized by forcep means engaging tissue proximate to said coronary artery on either side of said arteriotomy.
19. The method of claim 15 wherein said separation of said left internal mammary artery from its support base is visualized by a thoracoscope.
20. The method of claim 15 wherein the formation of said arteriotomy in said coronary artery is visualized by a thoracoscope.
21. The method of claim 15 wherein the completion of said anastomosis is visualized by a thoracoscope.
22. The method of claim 15 wherein said anastomosis is completed using a graft selected from the group consisting of a harvested artery, a harvested vein, and a synthetic graft.
US08419991 1995-04-10 1995-04-10 Method for coronary artery bypass Expired - Fee Related US5888247A (en)
US09390821 US6332468B1 (en) 1995-04-10 1999-09-07 Method for coronary artery bypass
US08889616 Continuation US5947125A (en) 1995-04-10 1997-07-07 Method for coronary artery bypass
US08889616 Continuation-In-Part US5947125A (en) 1995-04-10 1997-07-07 Method for coronary artery bypass
US5888247A true US5888247A (en) 1999-03-30
US20140052194A1 (en) * 2009-12-18 2014-02-20 Charles River Engineering Solutions And Technologies, Llc Articulating tool and methods of using
US9867625B2 (en) 2011-03-18 2018-01-16 Marine Polymer Technologies, Inc. Methods and apparatus for a manual radial artery compression device
GB1526933A (en) 1974-09-13 1978-10-04 Johnson Matthey Co Ltd Vacuum head for handling transfers
DE3801666A1 (en) 1988-01-21 1989-07-27 Masa Maschinenfabrik Olga Koss Elastic suction cups available for sensitive objects
"A Case of Treating Abrupt Closure Due to Post PTCA Dissection by Emergent CABG-Reoperation, Via Extracorporeal Circulatory Method Conducted with the Heart `Beating`," Kawase Y, Tanake N, Mukai K, Matsumoto Y, Kawasuji M, and Watanabe Y. (English Abstract Only Attached)
"A Compact Single Post Internal Mammary Artery Dissection Retractor," JG Vincent Eur. J. Cardiothorac Surg., 1989, vol. 3, pp. 276-277.
"A Minimally Invasive Surgical Method for Coronary Revascularization--Preliminary Experience in Five Patients," MC Robinson, DR Gross, and W Zeman Circulation, (Oct. 15, 1995) vol. 92, No. 8, I-176.
"A Modified Sternal Retractor for Exposure of the Internal Mammary Artery," PP McKeown, J Crew, ES Hanna, and R Jones The Annals of Thoracic Surgery, vol. 32, Jul.-Dec. 1981, p. 619.
"A Modified Sternal Retractor," N Ancalmo and JL Ochsner The Annals of Thoracic Surgery, vol. 21, Jan.-Jun. 1976, p. 174.
"A New Concept in Sternal Retraction: Applications for Internal Mammary Artery Dissection and Valve Replacement Surgery," A Chaux and C Blanche Ann. Thorac. Surg., vol. 42, Oct. 1986, pp. 473-474.
"A New Internal Mammary Artery Retractor," M. Bugge Thorac. Cardiovasc. Surgeon, vol. 38, 1990, pp. 316-317.
"An Alternative Approach to Isolated Circumflex Coronary Bypas Reoperations," Cheung D, Flemma RJ, Mullen DC, Lepley D, Jr. The Annals of Thoracic Surgery, 1982, vol. 33, pp. 302-303.
"Anastomosis Mamariocoronaria Sin Circulacion Extracorporea," FJ Benetti, J Rizzardi R Aun, et al. Prense Medica Argen., 1986, vol. 73, pp. 213-215.
"Avoidance of Patent Anterior Grafts at Revisional Coronary Artery Surgery: Use of a Lateral Thoracotomy Approach," Walker, WS, Sang CTM. Thorax, 1986, vol. 41, pp. 692-695.
"Bypass Senza Spargimento di Sangue," Allori L. Salve, 1995, N.2, pp. 38-42.
"Cardiopulmonary Bypass and Coronary Artery Bypass Graft," Corso PG. Chest, 1991, vol. 100.
"Closed-Chest Coronary Artery Bypass with Cardioplegic Arrest in the Dog," JH Stevens, LC Siegel, RS Mitchell, TA Burdon, GH Ribakove, JA SMith, FG St. Goar, WS Peters, MA Vierra, MF Pompili, and BA Reitz Circulation, vol. 90, No. 4, Part 2, Oct. 1994, p. I-251.
"Composite Arterial Conduits for a Wider Arterial Myocardial Revascularization," AM Calafiore, GD Giammarco, N Luciani, et al. Ann. Thorac. Surg., 1994, vol. 58, pp. 185-190.
"Controversies in Myocardial Revascularization: Coronary Artery Surgery for Single-Vessel Disease," CW Akins Seminars in Thoracic and Cardiovascular Surgery, (Apr. 1994) vol. 6, No. 2, pp. 109-115.
"Coronary Artery Bypass Grafting Surgery Without Cardiopulmonary Bypass," Kyobu N, Zasshi GG. (English Abstract Only Attached) Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, Kurme, Japan, 1993, vol. 4(4), pp. 598-602.
"Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass," Arsiwala S, Bedi HS, Sharma VK, and Trehan N. Indian Heart Journal, 1990, vol. 42, No. 6, pp. 453-454.
"Coronary Artery Bypass Surgery," BW. Lytle and DM Cosgrove III Current Problems in Surgery, (Oct. 1992), vol. XXIX, No. 10, pp. 737-807.
"Coronary Artery Bypass Without Cardiopulmonary Bypass," A.J. Pfister, MD; M.S. Zaki, MD; J.M. Garcia, MD; L.A. Mispireta, MD; P.J. Corso, MD; A.G. Qazi, MD; S.W. Boyce, MD; T.R. Coughlin, Jr., MD; and P. Gurny, MD The Annals of Thoracic Surgery, vol. 54, No. 6, Dec. 1992, pp. 1085-1092.
"Coronary Artery Bypass Without Cardiopulmonary Bypass--the Pros and the Cons," Moshkovitz Y, and Mohr R. Isr J Med Sci, 1993, vol. 29, pp. 716-720.
"Coronary Artery Bypass Without Extracorporeal Circulation Versus Percutaneous Transluminal Coronary Angioplasty: Comparison of Costs," Benetti FJ. The Journal of Thoracic and Cardiovascular Surgery, 1991, vol. 102, No. 5, pp. 802-803.
"Coronary Artery Revascularization Without Cardiopulmonary Bypass," R. Archer, D.O.; D.A. Ott, M.D.; R. Parravicini, M.D.; D.A. Cooley, M.D., G.J. Reul, M.D.; O.H. Frazier, M.D.; J.M. Duncan, M.D.; J.J. Livesay, M.D., and W.E. Walker, M.D. Texas Heart Institute Journal, vol. 11, No. 1, Mar. 1984, pp. 52-57.
"Coronary Artery Surgery Without Cardiopulmonary Bypass: Usefulness of the Surgical Blower-Humidifier," Maddaus M, Ali I, Birnbaum P, Panos AL, and Salerno TA. Journal of Cardiac Surgery, 1992, vol. 7, No. 4.
"Coronary Surgery Without Cardiopulmonary Bypass," S Westaby The Heart Journal, (Mar. 1995).
"Current Status of Cardiac Surgery: A 40-Year Review," W.E. Richenbacher, MD; J.L. Myers, MD, FACC; J.A. Waldhausen, MD, FACC Journal of the American College of Cardiology, vol. 14, No. 3, pp. 535-544.
"Direct Coronary Surgery with Saphenous Vein Bypass Without Either Cardiopulmonary Bypass or Cardiac Arrest," F.J. Benetti The Journal of Cardiovascular Surgery, vol. 26, No. 3, May-Jun., 1985, pp. 217-222.
"Direct Myocardial Revascularization by Saphenous Vein Graft," R.G. Favaloro, M.D.; D.B. Effler, M.D.; L.K. Groves, M.D.; W.G. Sheldon, M.D.; and F.M. Sones, Jr., M.D. The Annals of Thoracic Surgery, vol. 10, No. 2, Aug., 1970.
"Direct Myocardial Revascularization Without Cardiopulmonary Bypass," E. Buffolo; J.C.S. Andrade; J.Succi; L.E.V. Leao, and C. Gallucci Thoac. Cardiovasc. Surgeon, 33 (1985) pp. 26-29.
"Direct Myocardial Revascularization Without Extracorporeal Circulation," F.J. Benetti, M.D.; G. Naselli, M.D.; M. Wood, M.D.; and L. Geffner, M.D. Chest, vol. 100, No. 2, Aug., 1991, pp. 312-316.
"Influence of the Internal-Mammary-Artery Graft on 10-Year Survival and Other Cardiac Events," FD Loop, B.W. Lytle, DMCosgrove, et al. N. Eng. J. Med., 1986, vol. 3145, No. 1, pp. 1-6.
"Internal Mammary Retractor," RA Beg, H Naraghipour, EB Kay, and P Rullo The Annals of Thoracic Surgery, vol. 39, No. 1, Jan. 1985, pp. 286-287.
"Left Thoracotomy Approach for Coronary Artery Bypass Grafting in Patients with Pericardial Adhesions," Gandjbakheh I, Acar C, and Cabrol C. The Annals of Thoracic Surgery, 1989, vol. 48, pp. 871-873.
"Left Thoracotomy for Reoperation for Coronary Revascularation," Faro RS, Javid H. Najafi H., C. Serry The Journal of Thoracic and Cardiovascular Surgery, 1982, vol. 84, pp. 453-455.
"Left Thoracotomy for Reoperative Coronary Bypass," Burlingame, MW, Bonchek, LI, and Vazales, BE. Journal of Thoracic Cardiovascular Surgery, 1988, vol. 95, pp. 508-510.
"Left Thoracotomy Reoperation for Coronary Artery Disease," Grosner, G, Lajos TZ, Schimertz G, Bergsland J. Journal of Cardiac Surgery, 1990, vol. 5, pp. 304-308.
"Left Thoracotyomy for Reoperative Coronary Artery Bypass Procedures," Ungerleider, RM, Mills NL, Wechsler, AS. The Annals of Thoracic Surgery, 1985, vol. 40, pp. 11-15.
"Leftsided Thoracotomy for Coronary Artery Reoperation," Borst HG. Thoraxchirurgie Vaskulare Chirurgie, 1978, vol. 26, pp. 95-97.
"Mammary Artery-Coronary Artery Anastomosis as Method of Treatment for Angina Pectoris," V.I. Kolessov, M.D. Thoracic and Cardiovascular Surgery, vol. 54, No. 4, Oct., 1967, pp. 535-544.
"Minimally Invasive Cardiopulmonary Bypass with Cardioplegic Arrest: A Closed Chest Technique with Equivalent Myocardial Protection," DS Schwartz; GH Ribakove, EA Grossi, JH Stevens, LC Siegel, FG St. Goar, WS Peters, D McLoughlin, FG Baumann, SB Colvin, and AC Galloway The Journal of Thoracic and Cardiovascular Surgery, (1996) vol. 111, No. 3.
"Minimally Invasive Coronary Artery Bypass Grafting," TE Acuff, RJ Landreneau, BP Griffith, and MJ Mack Ann Thorac Surg (1996), vol. 61, pp. 135-137.
"Minimally Invasive Coronary Artery Bypass Grafting: A New Method Using an Anterior Mediastinotomy," MC Robinson, DR Gross, W Zeman, and E Stedje-Larsen. Journal of Cardiac Surgery, 1995, vol. 10, pp. 529-536.
"Placement of Coronary Artery Bypass Graft Without Pump Oxygenator," WG. Trapp and R Bisarya The Annals of thoracic Surgery, (Jan. 1975) vol. 19, No. 1, pp. 1-9.
"Preservation of Interventricular Septal Function in Patients Having Coronary Artery Bypass Grafts Without Cardiopulmonary Bypass," C.W. Akins, M.D.; C.A. Boucher, M.D., and G.M. Pohost, M.D. American Heart Journal, vol. 107, No. 2, Feb., 1984, pp. 304-309.
"Reoperation for Stenotic Saphenous Vein Bypass Grafts Without Cardiopulmonary Bypass," Akins CA. The Annals of Thoracic Surgery, 1983, vol. 35, No. 2, pp. 201-206.
"Reoperative Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass," W.J. Fanning, MD: G.S. Kakos, MD; and T.E. Williams, Jr., MD, PhD The Annals of Thoracic Surgery, vol. 55, No. 2, Feb. 1993, pp. 486-489.
"Right Anterolateral Thoracotomy for Repair of Atrial Septal Defect," Grinda JM, Folliguet TA, Dervanian P, Mace L, Legault B, Neveux JY. Ann Thorac Surg 1996, vol. 62, pp. 175-178.
"Right Thoracotomy for Reoperative Right Coronary Artery Bypass Procedures," Uppal R, Wolfe WG, Lowe JE, and Smith PK. The Annals of Thoracic Surgery, 1994, vol. 57, pp. 123-125.
"Simplified Lateral Chest Incision for Most Thoracotomies Other Than Sternotomy," Mithcell R, Angell W, Wuerflein R, and Dor V. The Annals of Thoracic Surgery, 1976, vol. 22, No. 3, pp. 284-286.
"Technical Considerations for Coronary Artery Bypass Without Cardioplegia," Bonchek LI. Journal of Cardiac Surgery, 1992, vol. 7, No. 4, pp. 333-341.
"The Impact of Additional Procedures on the Cost at Three Years of Coronary Angioplasty and Cornoary Surgery in the East Trial," WS Weintraub, PD Mauldin, E Becker, and SB King III Circulation, vol. 90, No. 4, Part 2, Oct. 1994, p. I-91.
"To Use or Not To Use the Pump Oxygenator in Coronary Bypass Operations," Drs. W.G. Trapp and R. Bisarya The Annals of Thoracic Surgery, vol. 19, No. 1, Jan., 1975, pp. 108-109.
"Total Revascularization with T Grafts," AJ Tector, S Amundsen, TM Schmahl, et al. Ann. Thorac Surg., 1994, vol. 57. pp. 33-39.
"Transaxillary Minithoracotomy: The Optimal Approach for Certain Pulmonary and Mediastinal Lesions," Becker RM and Munro DD. The Annals of Thoracic Surgery, 1976, vol. 22, No. 3, pp. 254-259.
"Two-Staged Repeat Myocardial Revascularization Through the Sternal Re-Entry and the Left Thoracotomy with Coronary Anastomosis Under the Beating Heart," Horii T, Suma H, Wanibuchi Y, Fukuda S, Kigawa I. (English Abstract Only Attached) Journal of the Japanese Association for Thoracic Surgery, 1993, vol. 41(9), pp. 1511-1514.
"Vertical Axillary Thoracotomy: A Functional and Cosmetically Appealing Incision," Baeza OR and Foster ED. The Annals of Thoracic Surgery, 1976, vol. 22, No. 3, pp. 287-288.
A Case of Treating Abrupt Closure Due to Post PTCA Dissection by Emergent CABG Reoperation, Via Extracorporeal Circulatory Method Conducted with the Heart Beating , Kawase Y, Tanake N, Mukai K, Matsumoto Y, Kawasuji M, and Watanabe Y. (English Abstract Only Attached) *
A Compact Single Post Internal Mammary Artery Dissection Retractor, JG Vincent Eur. J. Cardiothorac Surg. , 1989, vol. 3, pp. 276 277. *
A Minimally Invasive Surgical Method for Coronary Revascularization Preliminary Experience in Five Patients, MC Robinson, DR Gross, and W Zeman Circulation , (Oct. 15, 1995) vol. 92, No. 8, I 176. *
A Modified Sternal Retractor for Exposure of the Internal Mammary Artery, PP McKeown, J Crew, ES Hanna, and R Jones The Annals of Thoracic Surgery , vol. 32, Jul. Dec. 1981, p. 619. *
A Modified Sternal Retractor, N Ancalmo and JL Ochsner The Annals of Thoracic Surgery , vol. 21, Jan. Jun. 1976, p. 174. *
A New Concept in Sternal Retraction: Applications for Internal Mammary Artery Dissection and Valve Replacement Surgery, A Chaux and C Blanche Ann. Thorac. Surg. , vol. 42, Oct. 1986, pp. 473 474. *
A New Internal Mammary Artery Retractor, M. Bugge Thorac. Cardiovasc. Surgeon , vol. 38, 1990, pp. 316 317. *
An Alternative Approach to Isolated Circumflex Coronary Bypas Reoperations, Cheung D, Flemma RJ, Mullen DC, Lepley D, Jr. The Annals of Thoracic Surgery , 1982, vol. 33, pp. 302 303. *
Anastomosis Mamariocoronaria Sin Circulacion Extracorporea, FJ Benetti, J Rizzardi R Aun, et al. Prense Medica Argen. , 1986, vol. 73, pp. 213 215. *
Avoidance of Patent Anterior Grafts at Revisional Coronary Artery Surgery: Use of a Lateral Thoracotomy Approach, Walker, WS, Sang CTM. Thorax , 1986, vol. 41, pp. 692 695. *
Bypass Senza Spargimento di Sangue, Allori L. Salve , 1995, N.2, pp. 38 42. *
Cardiopulmonary Bypass and Coronary Artery Bypass Graft, Corso PG. Chest , 1991, vol. 100. *
Closed Chest Coronary Artery Bypass with Cardioplegic Arrest in the Dog, JH Stevens, LC Siegel, RS Mitchell, TA Burdon, GH Ribakove, JA SMith, FG St. Goar, WS Peters, MA Vierra, MF Pompili, and BA Reitz Circulation , vol. 90, No. 4, Part 2, Oct. 1994, p. I 251. *
Composite Arterial Conduits for a Wider Arterial Myocardial Revascularization, AM Calafiore, GD Giammarco, N Luciani, et al. Ann. Thorac. Surg. , 1994, vol. 58, pp. 185 190. *
Controversies in Myocardial Revascularization: Coronary Artery Surgery for Single Vessel Disease, CW Akins Seminars in Thoracic and Cardiovascular Surgery , (Apr. 1994) vol. 6, No. 2, pp. 109 115. *
Coronary Artery Bypass Grafting Surgery Without Cardiopulmonary Bypass, Kyobu N, Zasshi GG. (English Abstract Only Attached) Department of Thoracic and Cardiovascular Surgery, St. Mary s Hospital, Kurme, Japan, 1993, vol. 4(4), pp. 598 602. *
Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass, Arsiwala S, Bedi HS, Sharma VK, and Trehan N. Indian Heart Journal , 1990, vol. 42, No. 6, pp. 453 454. *
Coronary Artery Bypass Surgery, BW. Lytle and DM Cosgrove III Current Problems in Surgery , (Oct. 1992), vol. XXIX, No. 10, pp. 737 807. *
Coronary Artery Bypass Without Cardiopulmonary Bypass the Pros and the Cons, Moshkovitz Y, and Mohr R. Isr J Med Sci , 1993, vol. 29, pp. 716 720. *
Coronary Artery Bypass Without Cardiopulmonary Bypass, A.J. Pfister, MD; M.S. Zaki, MD; J.M. Garcia, MD; L.A. Mispireta, MD; P.J. Corso, MD; A.G. Qazi, MD; S.W. Boyce, MD; T.R. Coughlin, Jr., MD; and P. Gurny, MD The Annals of Thoracic Surgery , vol. 54, No. 6, Dec. 1992, pp. 1085 1092. *
Coronary Artery Bypass Without Extracorporeal Circulation Versus Percutaneous Transluminal Coronary Angioplasty: Comparison of Costs, Benetti FJ. The Journal of Thoracic and Cardiovascular Surgery , 1991, vol. 102, No. 5, pp. 802 803. *
Coronary Artery Revascularization Without Cardiopulmonary Bypass, R. Archer, D.O.; D.A. Ott, M.D.; R. Parravicini, M.D.; D.A. Cooley, M.D., G.J. Reul, M.D.; O.H. Frazier, M.D.; J.M. Duncan, M.D.; J.J. Livesay, M.D., and W.E. Walker, M.D. Texas Heart Institute Journal , vol. 11, No. 1, Mar. 1984, pp. 52 57. *
Coronary Artery Surgery Without Cardiopulmonary Bypass: Usefulness of the Surgical Blower Humidifier, Maddaus M, Ali I, Birnbaum P, Panos AL, and Salerno TA. Journal of Cardiac Surgery , 1992, vol. 7, No. 4. *
Coronary Revascularization with Arterial Conduits Via a Small Thoracotomy and Assisted by Thoracoscopy, Although Without Cardiopulmonary Bypass, FJ Benetti and C Ballester Cor Europaeum , (1995) vol. 4(1), pp. 22 24. *
Coronary Surgery Without Cardiopulmonary Bypass, S Westaby The Heart Journal , (Mar. 1995). *
Current Status of Cardiac Surgery: A 40 Year Review, W.E. Richenbacher, MD; J.L. Myers, MD, FACC; J.A. Waldhausen, MD, FACC Journal of the American College of Cardiology , vol. 14, No. 3, pp. 535 544. *
Direct Coronary Surgery with Saphenous Vein Bypass Without Either Cardiopulmonary Bypass or Cardiac Arrest, F.J. Benetti The Journal of Cardiovascular Surgery , vol. 26, No. 3, May Jun., 1985, pp. 217 222. *
Direct Myocardial Revascularization by Saphenous Vein Graft, R.G. Favaloro, M.D.; D.B. Effler, M.D.; L.K. Groves, M.D.; W.G. Sheldon, M.D.; and F.M. Sones, Jr., M.D. The Annals of Thoracic Surgery , vol. 10, No. 2, Aug., 1970. *
Direct Myocardial Revascularization Without Cardiopulmonary Bypass, E. Buffolo; J.C.S. Andrade; J.Succi; L.E.V. Leao, and C. Gallucci Thoac. Cardiovasc. Surgeon , 33 (1985) pp. 26 29. *
Direct Myocardial Revascularization Without Extracorporeal Circulation, F.J. Benetti, M.D.; G. Naselli, M.D.; M. Wood, M.D.; and L. Geffner, M.D. Chest , vol. 100, No. 2, Aug., 1991, pp. 312 316. *
Influence of the Internal Mammary Artery Graft on 10 Year Survival and Other Cardiac Events, FD Loop, B.W. Lytle, DMCosgrove, et al. N. Eng. J. Med. , 1986, vol. 3145, No. 1, pp. 1 6. *
Internal Mammary Retractor, RA Beg, H Naraghipour, EB Kay, and P Rullo The Annals of Thoracic Surgery , vol. 39, No. 1, Jan. 1985, pp. 286 287. *
Japanese Journal of Thoracic Surgery , 1993, vol. 46(6), pp. 512 515. *
Left Thoracotomy Approach for Coronary Artery Bypass Grafting in Patients with Pericardial Adhesions, Gandjbakheh I, Acar C, and Cabrol C. The Annals of Thoracic Surgery , 1989, vol. 48, pp. 871 873. *
Left Thoracotomy for Reoperation for Coronary Revascularation, Faro RS, Javid H. Najafi H., C. Serry The Journal of Thoracic and Cardiovascular Surgery , 1982, vol. 84, pp. 453 455. *
Left Thoracotomy for Reoperative Coronary Bypass, Burlingame, MW, Bonchek, LI, and Vazales, BE. Journal of Thoracic Cardiovascular Surgery , 1988, vol. 95, pp. 508 510. *
Left Thoracotomy Reoperation for Coronary Artery Disease, Grosner, G, Lajos TZ, Schimertz G, Bergsland J. Journal of Cardiac Surgery , 1990, vol. 5, pp. 304 308. *
Left Thoracotyomy for Reoperative Coronary Artery Bypass Procedures, Ungerleider, RM, Mills NL, Wechsler, AS. The Annals of Thoracic Surgery , 1985, vol. 40, pp. 11 15. *
Leftsided Thoracotomy for Coronary Artery Reoperation, Borst HG. Thoraxchirurgie Vaskulare Chirurgie , 1978, vol. 26, pp. 95 97. *
Mammary Artery Coronary Artery Anastomosis as Method of Treatment for Angina Pectoris, V.I. Kolessov, M.D. Thoracic and Cardiovascular Surgery , vol. 54, No. 4, Oct., 1967, pp. 535 544. *
Minimally Invasive Cardiopulmonary Bypass with Cardioplegic Arrest: A Closed Chest Technique with Equivalent Myocardial Protection, DS Schwartz; GH Ribakove, EA Grossi, JH Stevens, LC Siegel, FG St. Goar, WS Peters, D McLoughlin, FG Baumann, SB Colvin, and AC Galloway The Journal of Thoracic and Cardiovascular Surgery , (1996) vol. 111, No. 3. *
Minimally Invasive Coronary Artery Bypass Grafting, TE Acuff, RJ Landreneau, BP Griffith, and MJ Mack Ann Thorac Surg (1996), vol. 61, pp. 135 137. *
Minimally Invasive Coronary Artery Bypass Grafting: A New Method Using an Anterior Mediastinotomy, MC Robinson, DR Gross, W Zeman, and E Stedje Larsen. Journal of Cardiac Surgery , 1995, vol. 10, pp. 529 536. *
Placement of Coronary Artery Bypass Graft Without Pump Oxygenator, WG. Trapp and R Bisarya The Annals of thoracic Surgery , (Jan. 1975) vol. 19, No. 1, pp. 1 9. *
Preservation of Interventricular Septal Function in Patients Having Coronary Artery Bypass Grafts Without Cardiopulmonary Bypass, C.W. Akins, M.D.; C.A. Boucher, M.D., and G.M. Pohost, M.D. American Heart Journal , vol. 107, No. 2, Feb., 1984, pp. 304 309. *
Regional Cardiac Wall Immunobilization for Open Chest and Closed Chest Coronary Artery Bypass Grafting on the Beating Heart: The Octopus Method, C Borst, EWL Jansen, PF Grundemann, JWF van Dongen, HJ Mansvel Beck, H Wesenhagen, PJ Slootweg, JJ Bredee Circulation , (Oct. 15, 1995) vol. 92, No. 8 supplement I, I 177. *
Reoperation for Stenotic Saphenous Vein Bypass Grafts Without Cardiopulmonary Bypass, Akins CA. The Annals of Thoracic Surgery , 1983, vol. 35, No. 2, pp. 201 206. *
Reoperative Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass, W.J. Fanning, MD: G.S. Kakos, MD; and T.E. Williams, Jr., MD, PhD The Annals of Thoracic Surgery , vol. 55, No. 2, Feb. 1993, pp. 486 489. *
Right Anterolateral Thoracotomy for Repair of Atrial Septal Defect, Grinda JM, Folliguet TA, Dervanian P, Mace L, Legault B, Neveux JY. Ann Thorac Surg 1996, vol. 62, pp. 175 178. *
Right Thoracotomy for Reoperative Right Coronary Artery Bypass Procedures, Uppal R, Wolfe WG, Lowe JE, and Smith PK. The Annals of Thoracic Surgery , 1994, vol. 57, pp. 123 125. *
Simplified Lateral Chest Incision for Most Thoracotomies Other Than Sternotomy, Mithcell R, Angell W, Wuerflein R, and Dor V. The Annals of Thoracic Surgery , 1976, vol. 22, No. 3, pp. 284 286. *
Technical Considerations for Coronary Artery Bypass Without Cardioplegia, Bonchek LI. Journal of Cardiac Surgery , 1992, vol. 7, No. 4, pp. 333 341. *
The Impact of Additional Procedures on the Cost at Three Years of Coronary Angioplasty and Cornoary Surgery in the East Trial, WS Weintraub, PD Mauldin, E Becker, and SB King III Circulation , vol. 90, No. 4, Part 2, Oct. 1994, p. I 91. *
To Use or Not To Use the Pump Oxygenator in Coronary Bypass Operations, Drs. W.G. Trapp and R. Bisarya The Annals of Thoracic Surgery , vol. 19, No. 1, Jan., 1975, pp. 108 109. *
Total Revascularization with T Grafts, AJ Tector, S Amundsen, TM Schmahl, et al. Ann. Thorac Surg. , 1994, vol. 57. pp. 33 39. *
Transaxillary Minithoracotomy: The Optimal Approach for Certain Pulmonary and Mediastinal Lesions, Becker RM and Munro DD. The Annals of Thoracic Surgery, 1976, vol. 22, No. 3, pp. 254 259. *
Two Staged Repeat Myocardial Revascularization Through the Sternal Re Entry and the Left Thoracotomy with Coronary Anastomosis Under the Beating Heart, Horii T, Suma H, Wanibuchi Y, Fukuda S, Kigawa I. (English Abstract Only Attached) Journal of the Japanese Association for Thoracic Surgery , 1993, vol. 41(9), pp. 1511 1514. *
Vertical Axillary Thoracotomy: A Functional and Cosmetically Appealing Incision, Baeza OR and Foster ED. The Annals of Thoracic Surgery , 1976, vol. 22, No. 3, pp. 287 288. *
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