HOW I DO IT : Off-Pump Myocardial Revascularization. The Single-Suture Technique: How to Avoid Any Complication

Abstract

To achieve a good exposure of coronary arteries, the singlesuture<br />technique allows a good exposure of the circumflex<br />territory. This suture may injure the organs situated behind<br />the pericardium. We suggest placing a single suture of silk in<br />the oblique sinus to allow a good elevation of the posterior<br />pericardium before placing the single suture. This simple and<br />inexpensive method avoids any damage to the structures<br />behind the pericardium.

Exposures of Lateral and Inferior Cardiac Surface for Coronary Anastomosis during Minimally Invasive Coronary Artery Bypass Grafting

“…Later, Ricci et al 8 proposed the use of a single oblique sinus suture in the exposure of the lateral surface of the heart. Other surgeons as well in various combinations 9 reported similar use of DPS. We used two DPSs on the posterior pericardium.…”

“…Later, Ricci et al 8 proposed the use of a single oblique sinus suture in the exposure of the lateral surface of the heart. 9,11 Because this procedure is performed through the left thorax, it allows viewing both the sides of the left pericardial flap, and hence, direct vision allows the surgeon to avoid these injuries. We used two DPSs on the posterior pericardium.…”

“…The esophagus, descending thoracic aorta, and pulmonary vein all are reportedly injured while placing these sutures. 9,11 Because this procedure is performed through the left thorax, it allows viewing both the sides of the left pericardial flap, and hence, direct vision allows the surgeon to avoid these injuries. We are continuing with this method of exposure in patients of multivessel MICABG.…”

Pericardial Sling Increases OPCAB Safety and Applicability

“…We now believe that these deep pericardial sutures are no longer required and are not without risk [3]. Injury to deep structures has been reported including fatal retro-pericardial hematoma from injury to an inferior pulmonary vein [4], fatal aortic tear [3], lung laceration [5], injury to the esophagus [6], and subcutaneous emphysema [7]. Careful attention to detail is one of several tips that have been offered to prevent these complications [8, 9].…”