Table 197 Contraindications for OPCAB

Relative Contraindications

1. Vessel diameter < 1.5 mm

2. Severe vessel calcification

3. Intramyocardial vessel

4. Severe cardiomegaly

Anterior MIDCAB is performed through a small minithoracotomy in the fourth intercostal space underneath the nipple. Grafting of mid-left anterior descending (LAD) and diagonal branches can be performed by this approach. The anterolateral MIDCAB approach is used to bypass the ramus intermedius and first obtuse marginal branch of the circumflex system. An incision is made in the third interspace from the midclavicular to anterior axillary fold. Bilateral internal mammary artery (IMA) grafting to the LAD and OM has been made possible by thoracoscopic mobilization of right IMA. Lateral MIDCAB is performed with a small lateral thoracotomy through the fifth or sixth intercostal space. Marginal branches of the circumflex artery are accessed through this incision. Right bucket handle partial sternotomy is usually performed through a lower right partial sternotomy for right IMA to mid-right coronary artery (RCA) anastomosis. Sometimes electrocardiographic changes and hemodynamic instability are the major problems, especially in case of proximal RCA stenosis.

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