Two-Vessel Off-Pump Coronary Artery Bypass Grafting by Left Thoracotomy in a Complex Reoperative Case
DOI:
https://doi.org/10.1532/HSF98.2013308Abstract
An 83-year-old male with a history of three prior sternotomies, including coronary artery bypass surgery (CABG), presented with unstable angina. Cardiac catheterization showed left main and triple-vessel disease. The saphenous vein graft (SVG) to the right coronary artery was diseased but patent, and the SVG to the left anterior descending artery (LAD) was occluded. Preoperative evaluation showed a heavily calcified ascending aorta and minimum disease on the descending aorta. He successfully underwent a left thoracotomy 2-vessel off-pump CABG using the descending aorta for the proximal anastomosis. The left thoracotomy approach is a useful alternative to avoid complications associated with resternotomy, especially in patients with a hostile chest, although visualization of the target vessels may be limited.References
Azoury FM, Gillinov AM, Lytle BW, Smedira NG, Sabik JF. 2001. Off-pump reoperative coronary artery bypass grafting by thoracotomy: patient selection and operative technique. Ann Thorac Surg 71:1959-1963.nBaumgartner FJ, Gheissari A, Panagiotides GP, et al. 1991. Off-pump obtuse marginal grafting with local stabilization: thoracotomy approach in reoperations. Ann Thorac Surg 68:946-948.nCheung D, Flemma RJ, Mullen DC, Lepley D, Jr. 1982. An alternative approach to isolated circumflex coronary bypass reoperations. Ann Thorac Surg 33:302-303.nDuarte CS, Moraes Neto FR, Moraes CR. 2007. Left thoracotomy for reoperations in myocardium revascularization. Rev Bras Cir Cardiovasc 22:341-345.nFollis FM, Pett SB, Jr., Miller KB, et al. 1999. Catastrophic hemorrhage on sternal reentry: still a dreaded complication? Ann Thorac Surg 68:2215-2219.nGillinov AM, Casselman FP, Lytle BW, et al. 1999. Injury to a patent left internal thoracic artery graft at coronary reoperation. Ann Thorac Surg 67:382-386.nNishi H, Mitsuno M, Yamamura M, et al. 2010. Safe approach for redo coronary artery bypass grafting—preventing injury to the patent graft to the left anterior descending artery. Ann Thorac Cardiovasc Surg 16:253-258.n
