Vettath's Technique of Long Mammary Patch Reconstruction of a Diffusely Diseased Left Anterior Descending Coronary Artery without Endarterectomy on the Beating Heart

Abstract

Surgery for diffuse coronary artery disease requires coronary reconstruction with or without endarterectomy. Considering the immediate and late postoperative problems of coronary endarterectomy, many surgeons now prefer coronary reconstruction without endarterectomy. Patch reconstruction of the diseased coronary artery with either the internal mammary artery or another conduit is an attractive option. This article describes the technique of long mammary patch reconstruction of the left anterior descending coronary artery without endarterectomy as an off-pump procedure.

Re-engineering in OPCAB—A Vettath’s perspective

“…Technical difficulties due to small caliber of target vessels or their intramyocardial course, poor exposure of target sites, precarious intraoperative haemodynamic state, electrophysiological instability and inexperience of the surgeon are some of the reasons for incomplete myocardial revascularisation. Today, we have no contraindications for OPCAB, the intramyocardial coronary arteries, small coronary arteries and diffuse coronary arteries [34,35], have been a thing of the past. Any patient who needs to undergo CABG could have his coronary artery bypass surgery done using the OPCAB technique (Figures 5 and 6).…”

Revascularisation Strategies in OPCAB (Off Pump Coronary Artery Bypass)

“…Because of the increasing number of diabetic patients and patients with diffusely diseased coronary arteries and with increasing amount of patients undergoing triple vessel stenting, cardiac surgeons end up getting the worst set of patients who needs a CABG. Hence, in this scenario we had developed our own technique of mammary patch on diffusely diseased LAD without endarterectomy on beating heart [6,7].…”