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Re-engineering in OPCAB—A vettath’s perspective

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World Journal of Cardiovascular Diseases 2013年第4期3卷 33-44页

作者： murali P. vettath Et Ismail Av Kannan Department of Cardiothoracic and Vascular Surgery International Center of Excellence in OPCAB Surgery Malabar Institute of Medical Sciences Kozhikode India

OPCAB (off pump coronary artery bypass) has become a preferred technique of coronary revascularization in India, and more so in the East. This technique was restarted by Buffalo and Bennetti who had published their results in 1985. Since then, there has been a great enthusiasm among coronary surgeons to develop and standardize this technique of CABG (coronary artery bypass grafting). In the late nineties, nearly all the coronary centers in India started performing this technique. But, by the early 2000, only a few surgeons continued this practice. Only those who could perform this OPCAB technique in nearly 100% of their patients continued this and the rest of them returned back to the conventional on pump CABG. To attain this result, we had to re-engineer our technique of anesthesia, surgical technique, stabilization, and positioning of the heart to enable us to perform OPCAB in all patients who needed CABG. We have analyzed our last 3000 patients operated by the same surgeon (Dr MPV), in the same center with the same team. As OPCAB was the only procedure performed for coronary revascularization, we have compared our first 1000 patients, with the second 2000 patients that underwent the procedure. Our technique and our results are presented.

关键词： CABG (Coronary Artery Bypass Grafting) OPCAB (Off Pump Coronary Artery Bypass) ONCAB (On Pump Coronary Artery Disease) Diffuse Coronary Artery Disease IABP (Intra-Aortic Balloon Pump) CPB (Cardiopulmonary Bypass)

Extracranial Internal Carotid Artery (ICA) Aneurysm Repair and End to End Anastamosis of the Artery

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World Journal of Cardiovascular Diseases 2019年第4期9卷 295-299页

作者： murali vettath Madhu Ravisankar Kannan Av Nitin Gangadharan Malabar Institute of Medical Sciences Kozhikode India Department of Cardiovascular and Thoracic Surgery MEITRA Hospital Kozhikode India

We present a case of extracranial internal carotid artery (ICA) aneurysm, which presented as an inflammatory submandibular swelling in the upper part of the right side of the neck. The lack of frank pulsatility and signs of inflammation though was a bit confusing, the Doppler and CT angiogram clinched the diagnosis. We were able to surgically resect and reform the ICA using the native vessel itself, which is an unusual technique, which we thought was worth presenting.

关键词： Internal Carotid Artery Aneurysm Repair

OPCAB (Off Pump Coronary Artery Bypass) for Kawasaki Disease

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Surgical Science 2018年第9期9卷 287-292页

作者： murali P. vettath Madhu Ravisankar Kannan Arunachalam Veluchamy Nitin Gangadharan Cardiovascular and Thoracic Centre MEITRA Hospital Kozhikode India Department of Cardiovascular and Thoracic Surgery MEITRA Hospital Kozhikode India

We hereby report a case of Kawasaki disease in a 32 year old male, with giant aneurysm of both coronary arteries and severe LV (left ventricular) dysfunction who underwent OPCAB (off pump coronary artery bypass grafting) two years ago. He presented with acute myocardial infarction of his anterior wall of left ventricle. He was stabilised with medical management and was taken up for surgery when his enzymes became normal. His LV function had improved over the time and now has a good ejection fraction.

关键词： Coronary Artery Disease Coronary Artery Aneurysm Kawasaki Disease OPCAB (Off Pump Coronary Artery Bypass)

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass —A vettath Modification

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World Journal of Cardiovascular Diseases 2016年第6期6卷 188-195页

作者： murali P. vettath Kannan A. Vellachamy Nitin Gangadharan Sanooj Ottuparakuzhiyil Jayaprakash Moothencherie Department of Cardiac Surgery Malabar Institute of Medical Sciences Kozhikode Kerala India Department of Cardiac Anaesthesia Malabar Institute of Medical Sciences Kozhikode Kerala India Department of Perfusion Technology Malabar Institute of Medical Sciences Kozhikode Kerala India

Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.

关键词： Off-Pump Coronary Artery Bypass (OPCAB) Surgery Intra-Aortic Balloon Pump (IABP)

Development of SIMS (Simple Indigenous Metallic Stabilizer) for OPCAB

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World Journal of Cardiovascular Diseases 2019年第5期9卷 324-330页

作者： murali P. vettath Kannan Arunachalam Venkatachalam Nitin Gangadharan Madhu Ravisankar Smera Koroth Gopalakrishnan Raman Meitra Hospital Kozhikode India

Development of a simple, reusable stabilizer for beating heart surgery has been long overdue. Every time a disposable stabilizer is used and discarded, we add to the carbon footprint we leave behind. We had been working on developing such a stabilizer, and had finally come up with a simple indigenous (reusable) metallic stabilizer (SIMS). We have used it for over 600 consecutive off pump coronary artery bypass (OPCAB) with excellent results. The anatomy of the stabilizer is described here along with a comparison of this stabilizer with the commercially available one.

关键词： SIMS OPCAB

Extended Use of vettath’s Anastomotic Obturator (VAO)

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Surgical Science 2011年第9期2卷 451-452页

作者： vettath Prabhakaran murali Ismail E. Thazhkuni Kannan A. Vellachamy 不详

Stroke rate in redo coronary artery bypass surgery has remained a stumbling block, where the aorta is used as origin for the top end of the vein graft. Avoiding the side-clamp on these redo aortas by using the vettath’s Anastomotic Obturator (VAO) technique of anatomosing the vein graft could bring this down. We have also been able to use this technique in combined aortic valve replacement and CABG. These two situations where the VAO is used are elucidated here.

关键词： Anastomosis Coronary Redo CABG. VAO

Extended Use of vettath’s Anastomotic Obturator (VAO)

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