Reoperative minimally invasive axillocoronary artery bypass to the obtuse marginal branch
N Ishibashi1, S Kamata, T Koyanagi
1Department of Cardiovascular Surgery, Sakakibara Heart Institute, Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Insights
A 73-year-old man with severe coronary artery disease underwent successful axillocoronary artery bypass grafting without cardiopulmonary bypass. This off-pump technique provided good clinical results for complex coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- The patient presented with unstable angina and severe three-vessel coronary artery disease.
- Previous coronary artery bypass grafting in 1979 utilized saphenous vein grafts.
Observation:
- Computed tomography revealed severe calcification and atherosclerosis in the ascending and descending aorta.
- The patient had undergone prior coronary artery bypass grafting.
Findings:
- Axillocoronary artery bypass was performed to the obtuse marginal branch.
- Left internal thoracic artery was used as an in situ graft to the left anterior descending artery.
- The procedure was successfully completed without cardiopulmonary bypass, with satisfactory graft function.
Implications:
- Off-pump coronary artery bypass grafting can be a viable option for patients with severe aortic atherosclerosis.
- Minimally invasive techniques may offer good clinical outcomes in complex coronary artery disease cases.
- This approach avoids the risks associated with cardiopulmonary bypass in high-risk patients.
Abstract:
A 73-year-old man was admitted with unstable angina, having severe coronary artery disease involving 3 vessels. He had undergone coronary artery bypass grafting to the left anterior descending artery and the obtuse marginal branch using saphenous vein grafts in 1979. Computed tomography showed severe calcium deposition and atherosclerosis in the ascending and descending aorta. We conducted axillocoronary artery bypass to the obtuse marginal branch and left internal thoracic artery as an in situ graft to the left anterior descending artery without cardiopulmonary bypass. Grafts were satisfactory and clinical results good.
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