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Minimally invasive axillary-coronary artery bypass
1Department of Cardiac Surgery, The Christ Hospital, Cincinnati, Ohio, USA. john_flege@trihealth.com
Insights
Minimally invasive coronary artery bypass surgery can utilize the axillary artery for grafts when the left internal mammary artery is unavailable. This approach proved successful in patients needing bypass to the anterior descending coronary artery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Left internal mammary artery (LIMA) unavailability poses challenges for minimally invasive coronary artery bypass grafting (CABG) to the left anterior descending (LAD) artery.
- Ascending aorta access is difficult via anterolateral thoracotomy for proximal anastomosis.
- Axillary artery offers a viable alternative for proximal graft connection in specific minimally invasive CABG scenarios.
Purpose of the Study:
- To evaluate the suitability of the axillary artery for proximal anastomosis in minimally invasive coronary bypass operations.
- To demonstrate the feasibility of axillary artery grafts for anterior descending coronary artery revascularization.
Main Methods:
- Ten patients underwent minimally invasive axillary-coronary artery bypass to the LAD.
- No cardiopulmonary bypass was employed during the procedures.
- Grafts consisted of saphenous vein (n=9) or radial artery (n=1).
Main Results:
- Successful graft achievement in all ten patients.
- Zero mortality or major complications were observed.
- Axillary artery anastomosis was technically feasible and effective.
Conclusions:
- Axillary artery grafts are a successful option for minimally invasive bypass to the LAD.
- This technique provides a valuable alternative when LIMA is not usable.
- Minimally invasive CABG using axillary artery grafts demonstrates safety and efficacy.
Background:
Some patients with proximal obstructive lesions of the left anterior descending coronary artery who are suitable for minimally invasive coronary bypass surgery do not have an available left internal mammary artery because it has already been used for a graft, is diseased or has been damaged. The ascending aorta is not accessible for proximal graft anastomosis from a small anterolateral thoracotomy used to expose the coronary artery. The aim of this report is to show that the axillary artery is suitable for the proximal anastomosis in minimally invasive coronary bypass operations.
Methods:
Ten patients had minimally invasive axillary-coronary artery bypass to the anterior descending coronary artery. Cardiopulmonary bypass was not used. The saphenous vein was used in nine and the radial artery in one.
Results:
Satisfactory grafts were achieved in all patients without mortality or major complications.
Conclusion:
Grafts from the axillary artery can be used successfully for minimally invasive bypass to the anterior descending coronary artery.