Off-pump axillo-coronary artery bypass: a simple approach for high-risk myocardial revascularization

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Case Reports

Background:

• Recurrent angina after multiple coronary artery bypass grafting (CABG) procedures presents a significant clinical challenge.
• Previous sternotomy and mediastinitis can increase the complexity and risks associated with repeat cardiac surgery.
• Severe aortic calcification further complicates reoperative CABG strategies.

Observation:

• A 66-year-old male experienced worsening angina post-second CABG, which was complicated by mediastinitis.
• Coronary angiography showed a occluded left anterior descending (LAD) artery bypass graft, a patent native LAD, and a stenotic circumflex artery.
• The patient had severely calcified ascending aorta.

Findings:

• An off-pump axillo-coronary artery bypass to the LAD was successfully performed.
• Simultaneous stenting of the stenotic circumflex artery was completed.
• This combined approach simplified the complex revascularization and mitigated operative risks.

Implications:

• Off-pump axillary artery bypass combined with percutaneous coronary intervention offers a viable alternative for complex, reoperative coronary artery disease.
• This strategy may reduce morbidity and mortality in high-risk patients with challenging anatomy.
• The patient remained symptom-free at 52-month follow-up, indicating durable results.