Redo CABG for ACS via the left thoracotomy using the PAS-port system to the descending thoracic aorta: a case report
Yoshinori Watanabe1, Takeshiro Fujii, Masanori Hara
1Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan.
Insights
A 74-year-old patient underwent a complex redo coronary artery bypass graft (CABG) surgery. The innovative PAS-Port system facilitated a safe and efficient procedure, minimizing operative time and preventing complications.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- A 74-year-old female patient with left main trunk (LMT) and triple vessel disease underwent initial coronary artery bypass graft (CABG) surgery.
- Postoperatively, the patient developed exertional dyspnea, and coronary angiography revealed severe stenosis in the saphenous vein graft (SVG).
Observation:
- An unsuccessful percutaneous coronary intervention attempt led to impending infarction, necessitating an emergent redo CABG.
- The procedure was performed via left thoracotomy, with intra-aortic balloon pumping (IABP) temporarily interrupted.
Findings:
- A proximal anastomosis was successfully created using the PAS-Port system, allowing for safe repositioning and resumption of IABP.
- The distal anastomosis was performed on the previously bypassed graft.
- The patient experienced no postoperative myocardial damage or complications and was discharged on postoperative day 21.
Implications:
- This case demonstrates the feasibility of a safe redo CABG using the PAS-Port system in a high-risk patient with acute coronary syndrome.
- The use of the PAS-Port system minimized operative time and facilitated a successful left thoracotomy approach for redo CABG.
Abstract:
A 74-year-old female patient with left main trunk (LMT) and triple vessel disease underwent coronary artery bypass graft (CABG) surgery. The patient began to experience exertional dyspnea. A coronary artery angiogram confirmed a severe stenosis in the proximal side of the saphenous vein graft (SVG). The patient had impending infarction immediately after the unsuccessful attempt for percutaneous coronary intervention, which resulted in an emergent CABG procedure. A left thoracotomy at the 4th intercostal space was made with the patient in the right lateral position. We then interrupted the use of intra-aortic balloon pumping (IABP), confirmed on transesophageal echocardiography (TEE) that the balloon was in a position distal to the target anastomosis site, and made a proximal anastomosis using the PAS-Port system (Cardica, Redwood City, CA, USA). After its successful deployment, IABP was repositioned back and resumed. The distal anastomosis was made to the previously bypassed graft. The patient had no postoperative myocardial damage or complications and was discharged on postoperative day 21. A redo CABG for post-CABG acute coronary syndrome patient was thought to be an extreme high risk; however, the operative time could be minimized by using the PAS-Port system, which enabled a safe redo CABG with left thoracotomy.
