[Revascularization surgery through left off-pump thoracotomy is a viable alternative for coronary bypass
Alberto Oviedo López1, Pedro López Valenzuela, Roberto Martínez Hernández
1División de Cirugía Cardiovascular, Unidad Médica de Alta Especialidad No. 1. Bajío, IMSS, México.
Insights
Minimally invasive coronary artery bypass surgery using antero-lateral thoracotomy offers a safe alternative for high-risk patients needing repeat revascularization. This approach demonstrated satisfactory outcomes and symptom relief at one-year follow-up.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary atherosclerosis is a progressive condition requiring repeat interventions.
- Conventional coronary artery bypass grafting (CABG) carries significant risks, especially in patients with multiple comorbidities.
- Minimally invasive techniques, such as off-pump coronary artery bypass (OPCAB) via small thoracotomy, are emerging alternatives.
Observation:
- Two high-risk patients with previous CABG presented with unstable angina and myocardial ischemia.
- Both patients had multiple comorbidities including diabetes, hypertension, and obesity.
- Minimally invasive OPCAB procedures were performed using antero-lateral thoracotomy.
Findings:
- Both patients experienced satisfactory clinical evolution and were discharged within 7 days.
- At one-year follow-up, both patients remained asymptomatic.
- The procedures involved bypass grafting to critical coronary arteries, including the left anterior descending and obtuse marginal arteries.
Implications:
- Antero-lateral thoracotomy OPCAB is a viable and effective option for selected high-risk patients requiring repeat coronary revascularization.
- This approach may reduce morbidity and mortality compared to conventional sternotomy.
- Further studies are warranted to establish the long-term efficacy and broader applicability of this technique.
Background:
Despite substantial advances in treatment, coronary atherosclerosis is a progressive disease, for this reason a second surgery is frequent. The left anterior small thoracotomy operation on a beating heart is an alternative with less morbidity and mortality than the conventional surgery.
Cases Report:
We report two cases of coronary surgery with limited access. The first corresponds to a 72-year-old man with diabetes, hypertension, dyslipidemia, obesity, with myocardial damage and bypass surgery to anterior descendent coronary artery and first diagonal coronary artery with saphenous vein graft performed 13 years ago. Due to unstable angina and positive test for myocardial ischemia, we performed bypass surgery of minimal access to the anterior descendent coronary artery and obtuse marginal coronary artery. The second case corresponds to a man with hypertension, diabetes, obesity, previous bypass surgery of two vessels performed 4 years ago, complicated with perioperative inferior myocardial infarction. Due to unstable angina and positive test for myocardial viability, we performed a re-do coronary artery bypass graft surgery to the left anterior descending artery and first diagonal coronary arteries through a minimal access incision. In both the clinical evolution was satisfactory, they were discharged 7 days after surgery and remain asymptomatic at one year of follow-up.
Conclusion:
The antero-lateral thoracotomy off-pump coronary bypass surgery is an alternative indicated in high risk patient with coronary revascularization.
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