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Minimally invasive direct coronary artery bypass grafting using the saphenous vein in redo CABG
S Hirai1, Y Hamanakae, N Mitsui
1Department of Thoracic Surgery, Hiroshima Prefecture Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima 734-8530, Japan.
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) offers a less invasive option for redo coronary artery bypass grafting (CABG). This study highlights its safety and efficacy using a saphenous vein graft in a complex redo CABG case.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- Redo CABG presents unique challenges, including graft availability and surgical approach.
- Minimally invasive direct coronary artery bypass (MIDCAB) has emerged as an alternative strategy.
Observation:
- A patient with prior CABG (median sternotomy, LIMA to LAD, GEA to PDA) required repeat revascularization.
- Previous grafts precluded the use of LIMA or GEA.
- MIDCAB was performed using a saphenous vein graft (SVG) from the left subclavian artery to a coronary artery via left minithoracotomy.
Findings:
- The left subclavian artery was chosen for anastomosis due to less disease and accessibility.
- Epicardial-pericardial adhesion facilitated the SVG-to-coronary anastomosis by reducing epicardial motion.
- The MIDCAB procedure was successfully completed with the SVG graft.
Implications:
- MIDCAB using SVG from the left subclavian artery is a safe and promising option for selected redo CABG patients.
- This approach expands revascularization possibilities when standard grafts are unavailable.
- Further studies are warranted to validate these findings in a larger cohort.
Abstract:
We describe a patient who underwent minimally invasive direct coronary artery bypass (MIDCAB), who had previously undergone coronary artery bypass grafting (CABG) through a median sternotomy with a left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD) and a right gastroepiploic artery (GEA) graft to the posterior descending artery. MIDCAB was less invasive and was an effective alternative procedure for the second operation. Because the patient had no LIMA or GEA available for a graft because of prior use, we used a saphenous vein graft (SVG) for bypassing from the left subclavian artery to the coronary artery by MIDCAB via a left minithoracotomy. The left subclavian artery was selected as the proximal anastomotic site because this artery was less diseased and was easier to reach. The SVG-to-coronary artery anastomosis was facilitated by firm adhesion between the epicardium and the pericardium, which reduced the motion of the epicardium itself. These results suggest that the procedure is safe and promising in selected cases of redo CABG.