Less invasive direct coronary artery bypass grafting using H graft for a patient with advanced prostatic cancer
Satoru Nishida1, Tamotsu Yasuda, Go Watanabe
1Division of Cardiac Surgery, Tokyo Medical University, Tokyo, Japan.
Insights
Minimally invasive direct coronary artery bypass grafting (MIDCAB) using an H graft offers a less invasive surgical option. This technique successfully revascularized a high-risk patient, demonstrating good graft flow and recovery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery disease necessitates revascularization, often in patients with comorbidities.
- Minimally invasive direct coronary artery bypass grafting (MIDCAB) aims to reduce surgical trauma.
Observation:
- A 74-year-old male with advanced prostatic cancer underwent MIDCAB using an H graft.
- A left anterior small thoracotomy approach was utilized.
- A radial artery segment was interposed between the left internal thoracic artery and the left anterior descending artery.
Findings:
- The H graft procedure demonstrated good diastolic flow (37 mL/min) via transit time flow measurements.
- The surgery was completed in 80 minutes with no blood product transfusion.
- Postoperative angiography confirmed a widely patent H graft.
Implications:
- The H graft technique is a viable alternative for coronary revascularization in high-risk patients.
- This approach minimizes surgical trauma while achieving successful outcomes.
- It offers a less invasive option for selected patients requiring coronary artery bypass grafting.
Abstract:
Minimally invasive direct coronary artery bypass grafting (MIDCAB) using an H graft was performed on a 74-year-old man with advanced prostatic cancer who needed coronary revascularization. Through a left anterior small thoracotomy, the left internal thoracic artery (LITA) and the left anterior descending artery (LAD) were cleared, and a short radial artery (RA) was placed in an end-to-side fashion between the LITA and LAD. The distal LITA was ligated to avoid potential steal phenomenon. A flow pattern through the RA graft evaluated by transit time flow measurements demonstrated good diastolic flow with a mean value of 37 mL/min. The total surgical duration was 80 min, and no blood products were required. A postoperative angiogram showed a widely patent H graft. The patient was relieved of chest pain and was discharged. The H graft procedure is a useful alternative technique to minimize the surgical trauma in limited situations such as a high-risk case.
