Off-Pump CABG Heart 2002
<p>Dec 23, 2007 10:08 PM
 
Technical problems of off-pump surgery.
 
The quality of the coronary anastomosis must be guaranteed.
 
Breakthru came with CadioThoacic Systems Ultima and Utrecht Octopus (to stabilize the heart during anast)
 
These allowed growth of off pump procedures from negligible in 1995 to 10% in 1999 and is
expected to be 50% in 2005.
 
But - also need a bloodless field;
 
Still experimental are the advanced robotic instruments
capable of increasing surgical dexterity sufficiently to enable
thorascopic bypass surgery, preferably with the aid of three
dimensional visualisation.w28 These systems have not yet
provided the breakthrough of total endoscopic CABG
(TECAB) mainly because of the <b>still substantial technical difficulty
in creating a robot-sewn anastomosis</b>. Currently, interest
seems to be shifting towards alternative, automated ways
of performing the distal coronary anastomoses. While <b>glued
anastomoses</b> certainly hold promise, most advancement has
been in the area of mechanical connecting systems such as
<b>small, intraluminal stent-like structures,</b> intraluminal magnets,
and extraluminal devices with small hooks. While these
connectors are already available for the larger, proximal anastomosis
on the aorta, the relatively small size of the coronary
arteries and their delicate, friable walls impose large obstacles
for the development of reliable systems that may ultimately
enable TECAB in large groups of patients.
 
 
 
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