[Atraumatic local interruption technique for coronary circulation in MIDCAB].

Abstract

Various methods have been employed for "local" interruption of the coronary blood flow before anastomosis during MIDCAB. However, coronary artery injury caused by a snare and coronary artery stenosis at the snare site resulting in late complications have been reported. We utilize a technique that minimizes the risk of injury to the coronary artery. At about 1 cm proximal to the coronary artery incision, expanded polytetrafluoroethylene (ePTFE) suture (GORE-TEX Suture CV-3 with an 18 mm needle that is tightly curved) is placed around the coronary artery, picking up a large chunk of myocardium with the curve of the needle. A Teflon felt is then attached, and threaded through a tourniquet. The tourniquet is tightened with the minimum strength needed for hemostasis. In order to avoid damage to the distal side of the coronary artery incision, a snare is not placed. Instead, an intraluminal occluder is used to block the blood flow. Anastomosis can easily be obtained with the use of a stabilizer. Hemorrhage from passage of suture is negligible, even during administration of 1.5 mg/kg heparin, because there is no difference between the diameter of the needle and that of the thread (diameter: 0.422 mm). The thread stretches minimally along the major axis but is flexible along the minor axis and thus produces less vascular wall trauma than does polypropylene thread. Furthermore, when the coronary artery is tightened through the cushiony myocardium and the Teflon felt by the flexible GORE-TEX thread, the injury to the coronary wall is minimized.