<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">SS</journal-id><journal-title-group><journal-title>Surgical Science</journal-title></journal-title-group><issn pub-type="epub">2157-9407</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/ss.2017.89044</article-id><article-id pub-id-type="publisher-id">SS-78927</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine&amp;Healthcare</subject></subj-group></article-categories><title-group><article-title>
 
 
  Mini OPCAB Mammary to Left Anterior Descending Artery
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Federico</surname><given-names>Benetti</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Natalia</surname><given-names>Scialacomo</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib></contrib-group><aff id="aff1"><addr-line>Cardiac Surgery, Benetti Foundation, Alem 1846, Rosario, Argentine</addr-line></aff><author-notes><corresp id="cor1">* E-mail:<email>federicobenetti@hotmail.com(FB)</email>;</corresp></author-notes><pub-date pub-type="epub"><day>04</day><month>09</month><year>2017</year></pub-date><volume>08</volume><issue>09</issue><fpage>407</fpage><lpage>413</lpage><history><date date-type="received"><day>July</day>	<month>27,</month>	<year>2017</year></date><date date-type="rev-recd"><day>Accepted:</day>	<month>September</month>	<year>3,</year>	</date><date date-type="accepted"><day>September</day>	<month>6,</month>	<year>2017</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  Introduction: Here we will describe the actual surgical technique to perform the left mammary artery bypass to the left anterior descending artery, and the results of this operation in the Benetti Foundation in the last 20 years. 
  Materials and Methods: The inclusion criteria for this operation were patients with a demonstrated predominant ischemia by functional test. In the patients with double, triple vessels disease or left main, the age was more than 65 years or and Euro score Risk of surgery of more than 4. The exclusion criteria were patients with more areas of ischemia and lesions that involved a considerable territory apart from the Lad and good candidates for surgery are younger than 65 years or the Euro score Risk of surgery were less than 4. Seventy patients were operated in the Foundation through LIMA to LAD Anastomosis with the MINI OPCABG technique. The average Preoperative Risk Euroscore was 3,5. Surgical Technique after open the lower part of the sternum, the left mammary artery is dissected around 8 cm. The pericardium is open and the mammary is connected to the left anterior descending. 
  Results: Operative mortality in this series was 0%. One patient was converted to sternotomy Off Pump (1, 4%). None of the grafts were revised after the measure with the Medistim System. 55 (79%) were extubated in the operating room. The average Hospitalization stay were 60 hours (D +_17 ci 95%), 16 patients with Lima to LAD were restudied in the initially experience with 100% patency, at 144 months, 82% of the patients were alive and 68% asymptomatic. 
  Conclusion: More clinical experience is important to find the definitive indications of this technique; and better technologies are required to be able to standardize this operation in definitive form.
 
</p></abstract><kwd-group><kwd>Mini OPCAB</kwd><kwd> Minimally Invasive Coronary Surgery</kwd><kwd> Off Pump Coronary</kwd><kwd> Coronary Off Pump</kwd><kwd> Lima to Lad</kwd></kwd-group></article-meta></front><body>


<sec id="s1"><title>1. Introduction</title><p>Trying to decrease the risks of the CABG and costs, in 1978 we popularized the Off Pump Coronary Artery Bypass Graft (OPCABG) and expanded the technique, addressing lesions of the circumflex system (CX) and applying it to diverse clinical scenarios [<xref ref-type="bibr" rid="scirp.78927-ref1">1</xref>] [<xref ref-type="bibr" rid="scirp.78927-ref2">2</xref>] . Several surgical approaches were tested, such as full sternotomy, no spreading sternotomy including left, anterolateral, posterolateral and right anterolateral thoracotomies, as well as partial sternotomy [<xref ref-type="bibr" rid="scirp.78927-ref3">3</xref>] . The video-assisted techniques in the nineties allowed, for the first time, to dissect the left internal thoracic artery (LITA) without opening the pleura cavity. The LITA was anastomosed to the left anterior descending (LAD) through a small left anterior thoracotomy [<xref ref-type="bibr" rid="scirp.78927-ref4">4</xref>] [<xref ref-type="bibr" rid="scirp.78927-ref5">5</xref>] [<xref ref-type="bibr" rid="scirp.78927-ref6">6</xref>] . In 1997, we performed for the first time an ambulatory coronary bypass through a xiphoid lower sternotomy incision (MINI OPCAB) using 3D technology to assist in the operation [<xref ref-type="bibr" rid="scirp.78927-ref7">7</xref>] [<xref ref-type="bibr" rid="scirp.78927-ref8">8</xref>] .</p><p>Seventy patients were operated with the MINI OPCABG technique with LITA to LAD bypass during the last 20 years in our Foundation. The average age was 67 years, 15 (21%) were female, 23 (33%) patients had triple vessels disease, 18 (26%) double vessels disease, 26 (37%) single vessel disease, 3 (4%) severe left main disease, 27 (39%) had previous infarction, 12 (17%) previous catheter intervention, 4 (6%) previous CABG. The average Euroscore preoperative risk in this series was 3,5 (<xref ref-type="table" rid="table1">Table 1</xref>).</p></sec>


<sec id="s2"><title>2. Surgical Technique</title><p>The patient is prepared as for standard Coronary bypass operation through sternotomy (<xref ref-type="fig" rid="fig1">Figure 1</xref>). The sternum is open up to the 3 or 4 intercostal space depending the anatomy (<xref ref-type="fig" rid="fig2">Figure 2</xref>). The mammary retractor is put place (<xref ref-type="fig" rid="fig3">Figure 3</xref>). The left mammary was dissected in general around 8 cm and isolated without</p><table-wrap id="table1" ><label><xref ref-type="table" rid="table1">Table 1</xref></label><caption><title> Sociodemographic and clinicalcharacteristics</title></caption>


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