The History of Opcab (Off Pump) Coronary Surgery Volume 1 - Issue 3

Federico Benetti^1,2* and Natalia Scialacomo²

• ¹President Benetti Foundation, Argentina
• ²Department of Cardiac Surgery, Argentina

Received: May 31, 2018;   Published: June 08, 2018

Corresponding author: Federico Benetti, President Benetti Foundation, Department of Cardiac Surgery Alem 1846, Rosario Santa Fe, Zip 2000, Argentina

DOI: 10.32474/SCSOAJ.2018.01.000111

Abstract PDF

After the advent of the heart-lung machine, few surgeons continued to use the OPCAB technique, Among those were Benetti and Buffolo from South America, who published in the early 1990s the first two large series on OPCAB surgery [1-3]. Several surgical approaches were tested, such as full sternotomy, no spreading sternotomy including left, anterolateral, Posterolateral and right anterolateral thoracotomies, as well as partial sternotomy [3]. The video-assisted techniques in the nineties allowed us, for the first time, to dissect the left internal thoracic artery (LITA) without opening the pleura cavity. The LITA was anastomosed to the left anterior descending (LAD) through a small left anterior thoracotomy and the MIDCAB operation was create [4-6].

Some technological development we invented, allow us to trained surgeons in 45 countries of the world [7,8]. BY 1999 more than 11 000 (10%) coronary operations were performed on the beating heart [9]. Although the MIDCAB is a good operation full or partial lower sternotomy carries little morbidity and allows excellent access for LAD and right coronary artery anastomoses. With further experience, the circumflex marginal vessels can be approached [10]. In 1997, we performed for the first time an ambulatory coronary bypass through a xiphoid lower sternotomy incision (MINI OPCAB) using 3D technology to assist in the operation [11,12]. In 1998 Didier Loulmet perform the first endoscopic bypass using robotic [13].

We used the right mammary as inflow from many years in sternotomy off pump when the patient had a porcelain aorta. And we expand this thecnique for the MINI OPCAB operation [14]. Despite advances in cardiopulmonary bypass (CPB) is still associated with significant morbidity due to its un-physiological nature. The morbidity rate has indeed remained high, particularly in the ever-increasing high-risk surgical population presenting with co-morbidities [15]. The contact of blood components with the artificial surfaces of the bypass circuit, aortic cross-clamping and reperfusion injury are considered the main causative factors of inflammatory response following cardiac surgery [16,17], no pulsatile flow, hypothermia, duration of CPB, hypo perfusion, and micro emboli contribute to end organ injury [18,19]. OPCAB surgery, by means avoiding CPB and cardioplegic arrest, produce significant benefits. In special in high risk patients OPCAB is an operation establish today world wide .The future requires to expand a bypass operation more minimally invasive: means apart of avoid the pump small incision; easy to reproduce and with possibilities to be done in the entire world.

1. Benetti FJ (1985) Direct coronary surgery with saphenous vein bypass without either bypass or cardiac arrest. J Cardiovasc Surg 26(3): 217- 222.
2. Buffolo E (1985) Direct Myocardial Revascularization without Cardiopulmonary Bypass. Thorac Cardiovasc Surg 33(1): 26-29.
3. Benetti FJ (1991) Direct Myocardial revascularization without extracorporeal circulation Experience in 700 patients. Chest 100(2): 312-316.
4. Benetti FJ (1994) Uso de la Toracoscopia en cirugía coronaria para la disección de la mamaria izquierda La Prensa Medica Argentina 9: 81-87.
5. Benetti (1995) Use of the Thoracoscopy and a minimal Thoracotomy in mammary coronary bypass to left descending artery, without extracorporeal circulation Experience in 2 cases. J Cardiovasc Surg 36(2): 159-161.
6. FJ Benetti (1999) Method for coronary artery bypass. US Patent 5.888,247 p.1-14.
7. Benetti (1999) Surgical Method For Stabilizing The Beating Heart During Coronary Artery Bypass Graft Surgery Us Patent Patent Number 5,894,843.
8. Benetti (1998) surgical devices for imposing a negative pressure to fix the position of cardiac tissue during surgery. US patent Number 5,727,569.
9. Westaby S, Benetti FJ (1996) Less invasive coronary surgery: consensus from the Oxford Meeting. Ann Thorac Surg 62: 924-931.
10. Cleveland JC, Shroyer LW, Chen AY (2001) Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 72(4): 1282-1289.
11. Benetti FJ (1999) Minimally Invasive coronary surgery (the xiphoid approach). Eur J Cardiothoracic Surg 16(2): S10-S11.
12. F J Benetti Xyphoid access for cardiac surgical procedures. US Patent 6199556 B1
13. Loulmet D, Carpentier A, d’Attellis N, Berrebi A, Cardon C, et al. (1999) Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments. J Thorac Cardiovasc Surg 118(1): 4-10.
14. Benetti FJ (2010) Xiphoid, Lower, Sternotomy Approach for Multivessel revascularization of the left internal mammary to the left anterior descending Artery and the Right internal mammary as inflow to the others vessels. The Heart Surgery Forum 13(1): E36-39.
15. Kirklin JK, Westaby S, Blackstone EH (1983) Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 86(6): 845-857.
16. Chamberlain MH, Ascione R, Reeves BC (2002) Evaluation of the effectiveness of off-pump coronary artery bypass surgery in high-risk patients: an observational study. Ann Thorac Surg 73(6): 1866-1873.
17. Edmunds LH (1998) Inflammatory response to CPB. Ann Thorac Surg 66: S12-S16.
18. HickeyP, Buckley M, Philibin D (1983) Pulsatile and nonpulsatile CPB: review of a counterproductive controversy. Ann Thorac Surg 36(6): 720- 737.
19. ClarkRE, Brillman J, Davies DA (1995) Microemboli during coronary artery bypass grafting: genesis and effect on outcome. J Thorac Cardiovasc Surg 109(2): 249-257.