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A New Retractor to Aid in Coronary Artery Surgery
HOW TO DO IT
A New Retractor to Aid in Coronary Artery Surgery A. J. DelRossi, M.D., and G. M. Lemole, M.D. ABSTRACT During coronary artery bypass grafting, exposing the arteries can be difficult, especially on the posterior and lateral aspects of the left ventricle. A silicone-covered flexible retractor has been modified to facilitate this procedure. Its central opening and easy malleability aid in myocardial retraction and coronary artery bypass grafting.
To visualize the circumflex coronary artery and its marginal branches, it is necessary to lift the heart and rotate the apex toward the right side. Often an assistant to the surgeon must manually immobilize the left ventricle. This can be fatiguing to the assistant and can also result in suboptimal exposure. Consequently, various retractors as well as "nets" have been used to cradle the heart while the saphenous vein is anastomosed to the coronary arteries.
Technique To aid in mobilization and exposure of the posterior and lateral coronary arteries, we have modified an existing malleable retractor* by cutting a central rectangular opening in it (Fig 1). The original retractor has a stainless steel core that is covered by silicone elastomers. This combination allows for easy malleability, allowing the retractor to be twisted into any shape. The silicone keeps the epicardium from "slipping," and its soft texture prevents tissue damage. The center of this retractor blade has a 5 x 2 cm rectangular opening. When the retractor is placed against the upended left ventricle, the two blades can be positioned to straddle the coronary artery that is to be bypassed (Fig 2). The coronary artery will then bulge through the *Retractor provided by ADC Medical, 400 Smith St, Farmingdale, NY 11735. From the Department of Thoracic and Cardiovascular Surgery, Deborah Heart and Lung Center, Browns Mills, NJ. Accepted for publication Aug 13, 1982. Address reprint requests to Dr. DelRossi, Department of Thoracic and Cardiovascular Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015.
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Fig 1. Silicone-covered flexible retractor with 5 x 2 cm rectangular opening.
102 The Annals of Thoracic Surgery Vol 36 No 1 July 1983
rectangular space and provide an open field for both surgeon and assistant to incise and probe, before anastomosing the reversed saphenous vein. Comment The retractor itself is easily shaped to conform to the heart contour, and its metal core will hold the heart gently but firmly. The malleable handle can be held comfortably by the assistant. Repeated steri1ization.scause no damage to the retractor, and the soft blue color does not reflect the operating room lights. We have used this retractor on more than 50 patients and have obtained adequate exposure of the left ventricle. A11 marginal branches of the circumflex coronary artery as well as the distal right coronary artery and posterior descending branch can be visualized easily.
Fig 2 . Retracted heart and exposed coronary artery.
A New Retractor to Aid in Coronary Artery Surgery A. J. DelRossi, M.D., and G. M. Lemole, M.D. ABSTRACT During coronary artery bypass grafting, exposing the arteries can be difficult, especially on the posterior and lateral aspects of the left ventricle. A silicone-covered flexible retractor has been modified to facilitate this procedure. Its central opening and easy malleability aid in myocardial retraction and coronary artery bypass grafting.
To visualize the circumflex coronary artery and its marginal branches, it is necessary to lift the heart and rotate the apex toward the right side. Often an assistant to the surgeon must manually immobilize the left ventricle. This can be fatiguing to the assistant and can also result in suboptimal exposure. Consequently, various retractors as well as "nets" have been used to cradle the heart while the saphenous vein is anastomosed to the coronary arteries.
Technique To aid in mobilization and exposure of the posterior and lateral coronary arteries, we have modified an existing malleable retractor* by cutting a central rectangular opening in it (Fig 1). The original retractor has a stainless steel core that is covered by silicone elastomers. This combination allows for easy malleability, allowing the retractor to be twisted into any shape. The silicone keeps the epicardium from "slipping," and its soft texture prevents tissue damage. The center of this retractor blade has a 5 x 2 cm rectangular opening. When the retractor is placed against the upended left ventricle, the two blades can be positioned to straddle the coronary artery that is to be bypassed (Fig 2). The coronary artery will then bulge through the *Retractor provided by ADC Medical, 400 Smith St, Farmingdale, NY 11735. From the Department of Thoracic and Cardiovascular Surgery, Deborah Heart and Lung Center, Browns Mills, NJ. Accepted for publication Aug 13, 1982. Address reprint requests to Dr. DelRossi, Department of Thoracic and Cardiovascular Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015.
101
Fig 1. Silicone-covered flexible retractor with 5 x 2 cm rectangular opening.
102 The Annals of Thoracic Surgery Vol 36 No 1 July 1983
rectangular space and provide an open field for both surgeon and assistant to incise and probe, before anastomosing the reversed saphenous vein. Comment The retractor itself is easily shaped to conform to the heart contour, and its metal core will hold the heart gently but firmly. The malleable handle can be held comfortably by the assistant. Repeated steri1ization.scause no damage to the retractor, and the soft blue color does not reflect the operating room lights. We have used this retractor on more than 50 patients and have obtained adequate exposure of the left ventricle. A11 marginal branches of the circumflex coronary artery as well as the distal right coronary artery and posterior descending branch can be visualized easily.
Fig 2 . Retracted heart and exposed coronary artery.