A Method of Retraction During Reoperative Coronary Operations Using the Favaloro Retractor

A Method of Retraction During Reoperative Coronary Operations Using the Favaloro Retractor Charles H. Antinori, MD, Dioscoro T. Villanueva, MD, Victor J. Manuele, MD, Joseph A. Kuchler, MD, and John Santaspirt, DO Cooper Hospital University Medical Center and Our Lady of Lourdes Medical Center, Camden, New Jersey

A method is described for using the Favaloro retractor to provide retraction during dissection of the anterior wall of the heart during reoperative cardiac operations. (Ann Thorac Surg 2989;48:440)

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eoperative coronary artery bypass grafting is becoming increasingly common. In our practice, approximately 10% of our open heart procedures are reoperations. Also, it has become clear that the internal mammary artery is the conduit of choice whenever it is available [l, 21. Frequently, the internal mammary arteries have not been used at the first operation and are still available at reoperation. In using the Favoloro retractor to dissect down the left internal mammary artery, we noted that it also made dissection of the anterior surface of the heart, particularly the areas overlying the ventricles, much easier, with much less strain on the operator and assistant. We have used this method of retraction for more than 1 year. We like it so much that we have started using it for reoperations even when the left internal mammary artery is not being used.

Technique

anterior surface of the right and left ventricle, with the retractor providing excellent exposure by placing steady tension on the adhesions over the anterior surface of the heart and providing easy access all the way to the apex. After the anterior surface of the left heart is freed, the Favoloro retractor is left in place and the left internal mammary artery is dissected down in the usual fashion using cautery and clips. We find it easier to dissect out the heart first, because once the mammary pedicle is dissected down, the pedicle and the edge of the pericardium fall into the operator’s field of view and make dissection of the adhesions over the heart more difficult. After the left internal mammary artery is taken down, the aorta and the right heart are freed and the patient is cannulated for bypass in the routine fashion. We usually dissect out the posterior aspect of the heart after the start of bypass.

Comment We describe a simple method for using the Favoloro retractor to provide exposure in dissecting out the anterior surface of the heart in reoperative cardiac operations. The Favoloro retractor provides strong and steady retraction and frees an assistant from a tedious task.

The initial median sternotomy incision is made, and the sternum is cut with the oscillating saw. The underside of the sternum is freed enough to allow placement of the Favoloro retractor. The left side of the sternum is then retracted, and the plane of dissection is carried along the

References

Accepted for publication June 16, 1989.

2. Cameron A, Kemp HG, Green GE. Coronary bypass surgery

1. Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the

internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 1988;314:1-6.

Address reprint requests to Dr Antinori, 455 Rte 70 W, Cherry Hill,

with the internal mammary artery graft: 15 year follow-up.

NJ 08002.

Circulation 1986;(Suppl3):30-6.

0 1989 by The Society of

Thoracic Surgeons

0003-4975/89/$3.50