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Clamp for Coronary Artery Operations
Clamp for Coronary Artery Operations Abhay Singh Walia, MCh, and Shrikant D. Kole, MCh Department of Cardiothoracic Surgery, Bombay Hospital Institute of Medical Sciences and Research Centre, Mumbai, India
Aortocoronary bypass grafting is an accepted procedure for ischemic heart disease. Proper visualization of the coronary artery is mandatory for good surgical anastomosis. This is essential when a coronary operation is performed without cardioplegia or in surgical procedures without bypass support. For better visualization of a
coronary artery, we are presenting a coronary artery clamp. We have used this clamp in minimally invasive coronary artery operations to achieve a bloodless field. (Ann Thorac Surg 1998;65:1475– 6) © 1998 by The Society of Thoracic Surgeons
A
bloodless field is a necessity in any coronary artery operation, especially in minimally invasive coronary artery operations. To achieve this, many techniques have been used, such as warm saline irrigation, snare sutures, tourniquets, blockers, silicone rubber loops, and gas jets [1–3]. In spite of these techniques, one assistant may be constantly required to keep the operative field dry with suction [1]. We have devised a clamp for coronary operations (CAS Clamp; Maruti Surgical Works, Mumbai, India) which achieves a good bloodless field.
Technique The CAS Clamp is a modified bulldog clamp of stainless steel. It has two needles, 15 mm in length, fixed to the clamp end in a perpendicular direction (Fig 1). The clamp is small and atraumatic. It can be used in two ways: (1) both needles can be buried vertically into the myocardium by the side of the coronary artery, thus compressing the myocardium to achieve compression of the coronary artery, or (2) the clamp can be positioned in such a manner that one needle lies anterior and the other posterior to the coronary artery in a horizontal plane. This procedure is more effective than the first (Fig 2). The clamp, being small and remaining fixed away from the site of the anastomosis, does not obscure the operative field. There is no entanglement of sutures, minimum instruments in the operative field, and no fear of injury to the coronary artery with this clamp. The needle puncture bleeding stops in a few minutes after removal of the clamp.
Fig 1. The CAS Clamp. (B 5 bulldog clamp; N 5 needle.)
we have been using this clamp for minimally invasive direct coronary artery bypass grafting and also routine coronary artery bypass grafting cases, for nearly all coronary arteries in which there is a retrograde or antegrade bleed. The needle puncture bleeding stops in a few minutes after removal of the clamp. We expect no injury to the coronary artery caused by this clamp as the clamp is applied about 3 to 4 mm away from the artery, which includes a bit of the myocardium. We do not recommend
Comment We find this clamp to be safe and effective in producing a clean operative field. We avoid endothelial damage caused by blockers [2] and prevent gas embolism as a result of gas jets [2] by using this clamp. For the past year Accepted for publication Nov 14, 1997. Address reprint requests to Dr Kole, S/2, Amrut Siddhi, 24 Ravi Industrial Compound, Near Anjali Society, Thane (W)-400 602, India.
© 1998 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
Fig 2. Clamp in situ. (C 5 chest spreader; CA 5 coronary artery; H 5 clamp in horizontal position; V 5 clamp in vertical position.) 0003-4975/98/$19.00 PII S0003-4975(98)00188-X
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HOW TO DO IT WALIA AND KOLE CORONARY ARTERY CLAMP
this clamp to be used for calcified vessels because it could cause trauma to the vessel.
References 1. Acuff TE, Landreneau RJ, Bartley PG, Mack MJ. Minimally
Ann Thorac Surg 1998;65:1475– 6
invasive coronary artery bypass grafting. Ann Thorac Surg 1996;61:135–7. 2. Teoh KHT, Panos AL, Harmantas AA, Lichtenstein SV, Salerno TA. Optimal visualization of coronary artery anastomoses by gas jet. Ann Thorac Surg 1991;52:564. 3. Salerno TA, Christakis GT, Abel J, et al. Technique and pitfalls of retrograde continuous warm blood cardioplegia. Ann Thorac Surg 1991;51:1023–5.
Notice From the American Board of Thoracic Surgery The American Board of Thoracic Surgery began its recertification process in 1984. Diplomates interested in participating in this examination should maintain a documented list of the operations they performed during the year prior to application for recertification. This practice review should consist of 1 year’s consecutive major operative experiences. (If more than 100 cases occur in 1 year, only 100 need to be listed.) They should also keep a record of their attendance at approved postgraduate medical education activities for the 2 years prior to application. A minimum of 100 hours of approved CME activity is required. In place of a cognitive examination, candidates for recertification will be required to complete both the general thoracic and cardiac portions of the SESATS VI syllabus (Self-Education/Self-Assessment in Thoracic Surgery). It is not necessary for candidates to purchase
© 1998 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
SESATS VI booklets prior to applying for recertification. SESATS VI booklets will be forwarded to candidates after their applications have been accepted. Diplomates whose 10-year certificates will expire in 2001 may begin the recertification process in 1999. This new certificate will be dated 10 years from the time of expiration of the original certificate. Recertification is also open to any diplomate with an unlimited certificate and will in no way affect the validity of the original certificate. The deadline for submission of applications is May 1, 1999. A recertification brochure outlining the rules and requirements for recertification in thoracic surgery is available upon request from the American Board of Thoracic Surgery, One Rotary Center, Suite 803, Evanston, IL 60201 (telephone: (847) 475-1520; fax: (847) 475-6240).
Ann Thorac Surg 1998;65:1476
•
0003-4975/98/$19.00
Aortocoronary bypass grafting is an accepted procedure for ischemic heart disease. Proper visualization of the coronary artery is mandatory for good surgical anastomosis. This is essential when a coronary operation is performed without cardioplegia or in surgical procedures without bypass support. For better visualization of a
coronary artery, we are presenting a coronary artery clamp. We have used this clamp in minimally invasive coronary artery operations to achieve a bloodless field. (Ann Thorac Surg 1998;65:1475– 6) © 1998 by The Society of Thoracic Surgeons
A
bloodless field is a necessity in any coronary artery operation, especially in minimally invasive coronary artery operations. To achieve this, many techniques have been used, such as warm saline irrigation, snare sutures, tourniquets, blockers, silicone rubber loops, and gas jets [1–3]. In spite of these techniques, one assistant may be constantly required to keep the operative field dry with suction [1]. We have devised a clamp for coronary operations (CAS Clamp; Maruti Surgical Works, Mumbai, India) which achieves a good bloodless field.
Technique The CAS Clamp is a modified bulldog clamp of stainless steel. It has two needles, 15 mm in length, fixed to the clamp end in a perpendicular direction (Fig 1). The clamp is small and atraumatic. It can be used in two ways: (1) both needles can be buried vertically into the myocardium by the side of the coronary artery, thus compressing the myocardium to achieve compression of the coronary artery, or (2) the clamp can be positioned in such a manner that one needle lies anterior and the other posterior to the coronary artery in a horizontal plane. This procedure is more effective than the first (Fig 2). The clamp, being small and remaining fixed away from the site of the anastomosis, does not obscure the operative field. There is no entanglement of sutures, minimum instruments in the operative field, and no fear of injury to the coronary artery with this clamp. The needle puncture bleeding stops in a few minutes after removal of the clamp.
Fig 1. The CAS Clamp. (B 5 bulldog clamp; N 5 needle.)
we have been using this clamp for minimally invasive direct coronary artery bypass grafting and also routine coronary artery bypass grafting cases, for nearly all coronary arteries in which there is a retrograde or antegrade bleed. The needle puncture bleeding stops in a few minutes after removal of the clamp. We expect no injury to the coronary artery caused by this clamp as the clamp is applied about 3 to 4 mm away from the artery, which includes a bit of the myocardium. We do not recommend
Comment We find this clamp to be safe and effective in producing a clean operative field. We avoid endothelial damage caused by blockers [2] and prevent gas embolism as a result of gas jets [2] by using this clamp. For the past year Accepted for publication Nov 14, 1997. Address reprint requests to Dr Kole, S/2, Amrut Siddhi, 24 Ravi Industrial Compound, Near Anjali Society, Thane (W)-400 602, India.
© 1998 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
Fig 2. Clamp in situ. (C 5 chest spreader; CA 5 coronary artery; H 5 clamp in horizontal position; V 5 clamp in vertical position.) 0003-4975/98/$19.00 PII S0003-4975(98)00188-X
1476
HOW TO DO IT WALIA AND KOLE CORONARY ARTERY CLAMP
this clamp to be used for calcified vessels because it could cause trauma to the vessel.
References 1. Acuff TE, Landreneau RJ, Bartley PG, Mack MJ. Minimally
Ann Thorac Surg 1998;65:1475– 6
invasive coronary artery bypass grafting. Ann Thorac Surg 1996;61:135–7. 2. Teoh KHT, Panos AL, Harmantas AA, Lichtenstein SV, Salerno TA. Optimal visualization of coronary artery anastomoses by gas jet. Ann Thorac Surg 1991;52:564. 3. Salerno TA, Christakis GT, Abel J, et al. Technique and pitfalls of retrograde continuous warm blood cardioplegia. Ann Thorac Surg 1991;51:1023–5.
Notice From the American Board of Thoracic Surgery The American Board of Thoracic Surgery began its recertification process in 1984. Diplomates interested in participating in this examination should maintain a documented list of the operations they performed during the year prior to application for recertification. This practice review should consist of 1 year’s consecutive major operative experiences. (If more than 100 cases occur in 1 year, only 100 need to be listed.) They should also keep a record of their attendance at approved postgraduate medical education activities for the 2 years prior to application. A minimum of 100 hours of approved CME activity is required. In place of a cognitive examination, candidates for recertification will be required to complete both the general thoracic and cardiac portions of the SESATS VI syllabus (Self-Education/Self-Assessment in Thoracic Surgery). It is not necessary for candidates to purchase
© 1998 by The Society of Thoracic Surgeons Published by Elsevier Science Inc
SESATS VI booklets prior to applying for recertification. SESATS VI booklets will be forwarded to candidates after their applications have been accepted. Diplomates whose 10-year certificates will expire in 2001 may begin the recertification process in 1999. This new certificate will be dated 10 years from the time of expiration of the original certificate. Recertification is also open to any diplomate with an unlimited certificate and will in no way affect the validity of the original certificate. The deadline for submission of applications is May 1, 1999. A recertification brochure outlining the rules and requirements for recertification in thoracic surgery is available upon request from the American Board of Thoracic Surgery, One Rotary Center, Suite 803, Evanston, IL 60201 (telephone: (847) 475-1520; fax: (847) 475-6240).
Ann Thorac Surg 1998;65:1476
•
0003-4975/98/$19.00