Port-Access Coronary Artery Bypass Surgery

As originally designed, the port-access system allows one to perform surgery with CPB and cardiac arrest but without a median sternotomy. CPB was facilitated by venous drainage from a cannula placed in the femoral vein and advanced into the inferior vena cava and right atrium. Cardiopulmonary venting was effected by a relatively large-bore catheter placed in the pulmonary artery through the right internal jugular vein. Similarly, a coronary sinus catheter was placed through the right internal jugular vein. Arterial return to the systemic circulation occurred through a special endarterial cannula placed by means of a cut-down in the femoral artery. This special cannula also allows the placement of an "endaortic clamp" in the ascending aorta (above the sinotubular junction and proximal to the innominate takeoff). TEE is used to facilitate correct placement, and the heart is isolated by inflation of a balloon within the aortic lumen. Cardiac arrest was effected by cardioplegia administered through a port that emptied into the ascending aorta proximal to the balloon. The surgical anastomoses were performed after exposure of the heart through a left minithoracotomy. The reported results have varied and range from those that are comparable with conventional CAB^{[336] [337]} to reports indicating significant complications related to femoral artery dissection. ^[338] In its complete form, the port-access approach has a steep learning curve that is not inexpensive. More commonly, specific features of this approach may be used in patients with special circumstances.