PREOPERATIVE DIAGNOSIS:
Chronic medically refractory angina.
POSTOPERATIVE DIAGNOSIS:
Chronic medically refractory angina.
PROCEDURE PERFORMED:
Minimally invasive sole therapy laser transmyocardial revascularization.
SURGEON: John Doe , MD
ANESTHESIA: General
endotracheal.
COMPLICATIONS: None.
DRAINS: One 19 French
Blake drain.
DESCRIPTION OF PROCEDURE:
The patient was identified and placed on the operative table in the
supine position. General endotracheal anesthesia was induced. The left chest
and groin were prepped and draped in the normal sterile fashion. The patient
was given IV antibiotics prior to start of the case. A standard 2 inch incision
was made below the left breast and dissection was carried down through the
fifth interspace. Once we entered the chest, we amputated the pericardial fat
pad and identified the pericardium. We made a window in the pericardium and
used stay sutures to make a well around the pericardium. Scarred ends of the
lung were scarred down and we pushed this out of the way. Once we had a
pericardial stay suture in place, we then meticulously took down all the
adhesions around the left ventricle, freeing up the left ventricle all the way
over to the great cardiac vein on the inferior wall, anteriorly to the level
around the apex, anteriorly to the level of the LAD and then laterally out to
the level of the vein graft. We then proceeded to place 35 laser TMR channels,
doing 5 at a time and using a 2 to 3 minute rest period in between each set of
5 channels. Each channel was placed about 1 cm apart from each other to cover
the entire ischemic area along the left ventricle. We did do most of the
channels in the area of the right coronary distribution and in the LV apex, 35 channels were
done in all. Once this was done, we then checked for bleeding. After several
minutes pressure, there was no evidence of any bleeding. We coated the heart
with Tisseel and loosely closed the pericardium over the top of the heart. We
then placed a 19 French Blake drain along the pericardium and then we injected
the wound with 0.25% Marcaine. We then placed a PainBuster pain device within
the subpleural space along the incision, and we then closed the incision using
one interrupted #2 Vicryl stitch. We then closed the pectoral muscle over the
top of this in one layer using running 0-Vicryl and then subcutaneous tissue
and the skin. The wounds were cleaned and dried. Sterile bandages were placed.
All needle, sponge and instrument counts were correct at the end of the case.
The patient tolerated the procedure well.
