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Self-retaining epicardial retractor for aortocoronary bypass surgery
Current Technique
Self-retaining epicardial retractor for aortocoronary bypass surgery A self-retaining epicardial retractor for use in aortocoronary bypass is described.
Victor Parsonnet, M.D., C. A. Oprisiu, M.D., Isaac Gielchinsky, M.D., Bhaktan Krishnan, M.D., and Ronald M. Abel, M.D., Newark, N. J.
Fig. 1. Photograph of the self-retaining retractor. Fig. 2. Photograph of a well-exposed diagonal branch of the left anterior descending coronary artery. A calibrated plastic probe lies within the lumen at the proximal end of the arteriotomy.
From the Department of Surgery, Newark Beth Israel Medical Center, Newark, N. J. Received for publication Nov. 6, 1978. Accepted for publication Dec. 14, 1978. Address for reprints: Victor Parsonnet, M.D., Department of Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave., Newark, N. J. 07112.
Aortocoronary bypass can be technically difficult, especially when the artery to be sutured lies deep in the epicardial fat or within the cardiac muscle. To facilitate exposure and suturing of such vessels we have designed a self-retaining retractor (manufactured by C. V. Mueller Co., Chicago, 111.).
0022-5223/79/040629+03$00.30/0 © 1979 The C. V. Mosby Co.
629
The Journal of
630
Parsonnet ef al.
Thoracic and Cardiovascular Surgery
Fig. 3. In the same patient, the left anterior descending lies deep in a cleft in the epicardium. (The completed diagonal bypass is seen in the upper right comer.) Fig. 4. Partially completed anastomosis to the well-exposed left anterior descending coronary artery.
Description of the device The retractor is made of spring steel (Fig. I) of sufficient strength to hold the epicardial fat or the myocardial muscle away from the artery. The retractor has three curved, dull prongs at each end. The prongs can be forced into the epicardial fat fairly easily. Illustrations of actual use are shown in Figs. 2 to 4. One can see the retractor holding the artery exposed, in this case a diagonal branch of the left anterior descending coronary artery (LAD) (Fig. 2) . Figs . 3 and 4 reveal this anastomosis completed and the LAD lying deep in
the fat (Fig . 3), but well exposed by the retractor during the anastomosis (Fig. 4) . Comment. We have used this retractor largely for lesions of the LAD when it lies in the fat or in the muscle, occasionally for a diagonal branch, and less commonly for obtuse marginal branches of the circumflex or the posterior descending coronary artery. In all of these positions the retractor fits comfortably and leaves room between the blades to perform the anastomosis .
Self-retaining epicardial retractor for aortocoronary bypass surgery A self-retaining epicardial retractor for use in aortocoronary bypass is described.
Victor Parsonnet, M.D., C. A. Oprisiu, M.D., Isaac Gielchinsky, M.D., Bhaktan Krishnan, M.D., and Ronald M. Abel, M.D., Newark, N. J.
Fig. 1. Photograph of the self-retaining retractor. Fig. 2. Photograph of a well-exposed diagonal branch of the left anterior descending coronary artery. A calibrated plastic probe lies within the lumen at the proximal end of the arteriotomy.
From the Department of Surgery, Newark Beth Israel Medical Center, Newark, N. J. Received for publication Nov. 6, 1978. Accepted for publication Dec. 14, 1978. Address for reprints: Victor Parsonnet, M.D., Department of Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave., Newark, N. J. 07112.
Aortocoronary bypass can be technically difficult, especially when the artery to be sutured lies deep in the epicardial fat or within the cardiac muscle. To facilitate exposure and suturing of such vessels we have designed a self-retaining retractor (manufactured by C. V. Mueller Co., Chicago, 111.).
0022-5223/79/040629+03$00.30/0 © 1979 The C. V. Mosby Co.
629
The Journal of
630
Parsonnet ef al.
Thoracic and Cardiovascular Surgery
Fig. 3. In the same patient, the left anterior descending lies deep in a cleft in the epicardium. (The completed diagonal bypass is seen in the upper right comer.) Fig. 4. Partially completed anastomosis to the well-exposed left anterior descending coronary artery.
Description of the device The retractor is made of spring steel (Fig. I) of sufficient strength to hold the epicardial fat or the myocardial muscle away from the artery. The retractor has three curved, dull prongs at each end. The prongs can be forced into the epicardial fat fairly easily. Illustrations of actual use are shown in Figs. 2 to 4. One can see the retractor holding the artery exposed, in this case a diagonal branch of the left anterior descending coronary artery (LAD) (Fig. 2) . Figs . 3 and 4 reveal this anastomosis completed and the LAD lying deep in
the fat (Fig . 3), but well exposed by the retractor during the anastomosis (Fig. 4) . Comment. We have used this retractor largely for lesions of the LAD when it lies in the fat or in the muscle, occasionally for a diagonal branch, and less commonly for obtuse marginal branches of the circumflex or the posterior descending coronary artery. In all of these positions the retractor fits comfortably and leaves room between the blades to perform the anastomosis .