Key result
Changing to a left lateral thoracotomy approach with specific operative and pharmaceutical interventions reduced the mortality rate in the sheep model from 45% to 0% (P<0.0001).
Why the study?
Does a modified surgical approach (left lateral thoracotomy) and prophylactic regimen reduce mortality in a sheep model of coronary artery bypass surgery?
Does a modified surgical approach (left lateral thoracotomy) and prophylactic regimen reduce mortality in a sheep model of coronary artery bypass surgery?
Absolute Event Rate: 0% vs 45%
p-value: p=<0.0001
A modified surgical approach using left lateral thoracotomy and prophylactic medical management significantly reduces mortality in sheep models of coronary artery bypass surgery.
Improves viability of ovine CABG models; leaves open translation to human surgical practice.
The sheep is considered to be a suitable model for cardiovascular surgery because of its ease of handling, size, and vascular anatomy which bears close resemblance to the human. Several difficulties, however, have limited the use of the sheep for such a purpose-mainly the high infection rate resulting from median sternotomy incision and its susceptibility to intractable ventricular fibrillation (VF) with the slightest manipulation of the heart, and even the risk of short periods of myocardial ischaemia. We have used the sheep model extensively to perform coronary artery bypass surgery and were successful in overcoming these difficulties. Fifty-seven adult female sheep were used to test a new anastomotic device for the creation of a sutureless connection between venous and arterial grafts and the coronary arteries. The study required full access to the heart and great vessels and mobilization of one of the internal mammary arteries. Changing to the left lateral thoracotomy (LLT) approach solved the initial fatal problems of postoperative infected median sternotomy incisions. Aggressive prophylactic treatment with anti-arrhythmic drugs, maintenance of normothermia and myocardial preconditioning rendered the heart much less vulnerable to manipulations and ischaemia. These measures have reduced the mortality rate from 45% to 0% (P <0.0001). With specific operative techniques and pharmaceutical interventions, the sheep can be effectively and safely used as a model for coronary artery surgery.
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Shofti et al. (2004) studied Coronary artery bypass surgery (animal model) (n=57). Left lateral thoracotomy approach, anti-arrhythmic drugs, normothermia, and myocardial preconditioning vs. Median sternotomy approach (initial) was evaluated on Mortality rate (p=<0.0001). Changing to a left lateral thoracotomy approach with specific operative and pharmaceutical interventions reduced the mortality rate in the sheep model from 45% to 0% (P<0.0001).
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