Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary
artery bypass (CABG)
surgery in multivessel
coronary artery disease. In contrast to standard open-chest
CABG surgery, which requires a median sternotomy or other gross
thoracotomy to
expose the patient's heart, post-access
CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial
bypass grafts, such as the internal mammary arteries and / or the right gastroepiploic
artery, are prepared for
grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous
vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the
coronary arteries under direct
visualization through a cardioscopic
microscope inserted through an intercostal
access port. Retraction instruments are provided to manipulate the heart within the closed chest of the patient to
expose each of the
coronary arteries for
visualization and
anastomosis. Disclosed are a tunneler and an articulated tunneling grasper for rerouting the graft vessels, and a finger-like
retractor, a suction cup
retractor, a snare
retractor and a loop retractor for manipulating the heart. Also disclosed is a port-access topical cooling device for improving myocardial protection during the port-access CABG procedure. An alternate
surgical approach using an anterior mediastinotomy is also described.