Thursday 23 June 2022

Lupine Publishers | The History of Opcab (Off Pump) Coronary Surgery

 Lupine Publishers | Journal of Surgery


After the advent of the heart-lung machine, few surgeons continued to use the OPCAB technique, Among those were Benetti and Buffolo from South America, who published in the early 1990s the first two large series on OPCAB surgery [1-3]. 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 [3]. The video-assisted techniques in the nineties allowed us, 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 and the MIDCAB operation was create [4-6].

Some technological development we invented, allow us to trained surgeons in 45 countries of the world [7,8]. BY 1999 more than 11 000 (10%) coronary operations were performed on the beating heart [9]. Although the MIDCAB is a good operation full or partial lower sternotomy carries little morbidity and allows excellent access for LAD and right coronary artery anastomoses. With further experience, the circumflex marginal vessels can be approached [10]. 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 [11,12]. In 1998 Didier Loulmet perform the first endoscopic bypass using robotic [13].

We used the right mammary as inflow from many years in sternotomy off pump when the patient had a porcelain aorta. And we expand this thecnique for the MINI OPCAB operation [14]. Despite advances in cardiopulmonary bypass (CPB) is still associated with significant morbidity due to its un-physiological nature. The morbidity rate has indeed remained high, particularly in the ever-increasing high-risk surgical population presenting with co-morbidities [15]. The contact of blood components with the artificial surfaces of the bypass circuit, aortic cross-clamping and reperfusion injury are considered the main causative factors of inflammatory response following cardiac surgery [16,17], no pulsatile flow, hypothermia, duration of CPB, hypo perfusion, and micro emboli contribute to end organ injury [18,19]. OPCAB surgery, by means avoiding CPB and cardioplegic arrest, produce significant benefits. In special in high risk patients OPCAB is an operation establish today world wide .The future requires to expand a bypass operation more minimally invasive: means apart of avoid the pump small incision; easy to reproduce and with possibilities to be done in the entire world.

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