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[On/off-pump beating coronary artery bypass grafting after thoracoplasty]
Noriyoshi Yashiki1, H Saito, R Kiuchi
1Department of Thoracic Surgery, Koseiren Takaoka Hospital, Takaoka, Japan.
Insights
Off-pump coronary artery bypass grafting (OPCAB) is suitable for patients with poor respiratory function post-thoracoplasty. Careful surgical planning is essential due to potential complications and the need for alternative support strategies.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Patients undergoing coronary artery bypass grafting (CABG) after thoracoplasty present unique surgical challenges.
- Pre-existing poor respiratory function in these patients necessitates careful consideration of surgical techniques.
Observation:
- Off-pump coronary artery bypass grafting (OPCAB) was performed in 3 post-thoracoplasty patients.
- Conventional on-pump CABG (cardiopulmonary bypass) was also considered.
Findings:
- OPCAB is often more suitable than conventional CABG in post-thoracoplasty patients with severe coronary lesions due to preserved respiratory function.
- Surgical access can be complicated by sternal inclination or pleural contamination, requiring meticulous technique.
- Challenges in achieving circumflex artery bypass in OPCAB may necessitate alternative strategies.
Implications:
- Percutaneous cardiopulmonary support (PCPS), cardiopulmonary bypass, or hybrid therapy should be considered pre-operatively.
- Careful pre-operative assessment and planning are crucial for successful CABG in this high-risk patient group.
Abstract:
Off-pump coronary artery bypass grafting (CABG) [OPCAB] or on-pump beating CABG (conventional CABG) was performed in 3 post-thoracoplasty patients. Considering their poor respiratory function after thoracoplasty, OPCAB is considered more suitable than conventional CABG with cardio-pulmonary bypass in such cases with severe coronary lesions. However, because the sternum inclines or the pleural cavity may be polluted in these patients, special care is necessary for the operation. In such cases, it may be impossible to bypass to the circumflex artery in OPCAB, and is necessary to consider the use of percutaneous cardiopulmonary support (PCPS), cardio-pulmonary bypass or hybrid therapy before the operation.
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