[Extended total arch replacement with coronary artery bypass grafting( CABG) via left thoracotomy;report of a case]
Hironobu Sugiyama1, Satoshi Tobe, Hiroki Nousho
1Department of Cardiovascular Surgery, Akashi Medical Center, Akashi, Japan.
Insights
This case study demonstrates a successful surgical approach for patients with aortic aneurysms and coronary artery disease. Combining aortic aneurysm repair with coronary artery bypass grafting via left thoracotomy offers a viable treatment option.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- The simultaneous surgical management of extensive aortic aneurysms and ischemic coronary artery disease presents significant challenges.
- Aortic aneurysm repair and coronary artery bypass grafting (CABG) are complex procedures, and their combined execution requires careful consideration.
Observation:
- A 70-year-old male patient with hepatic disease was diagnosed with an expanding aortic thoracic aneurysm.
- Computed tomography (CT) confirmed an aneurysm of the aortic arch and descending thoracic aorta.
- Coronary arteriography (CAG) revealed severe stenosis in coronary arteries (#7 90% and #13 75%).
Findings:
- The patient underwent successful replacement of the aortic arch and descending thoracic aneurysm combined with CABG.
- The surgical approach utilized was a left thoracotomy, allowing for a minimally invasive procedure.
- Postoperative CT scans confirmed the patency of both the synthetic aortic graft and the coronary bypass grafts.
Implications:
- This case highlights the feasibility and safety of performing combined aortic aneurysm repair and CABG through a left thoracotomy.
- The successful outcome suggests this approach can be an effective strategy for managing patients with concurrent aortic and coronary artery disease.
- Further research may explore the long-term outcomes and broader applicability of this surgical technique.
Abstract:
The operative procedure of extensive aortic aneurysm with ischemic coronary artery disease is controversial. We report a case of arch and descending thoracic aortic aneurysm replacement with coronary artery bypass grafting(CABG)via left thoracotomy. A 70-year-old man followed up by hepatic disease was diagnosed with expanding aortic thoracic aneurysm at the other hospital. He had admission to our hospital for surgical intervention. Computed tomography(CT)revealed arch and descending thoracic aortic aneurysm, and coronary arteriography (CAG) revealed #7 90% and #13 75% stenosis. We performed arch and descending thoracic aortic aneurysm replacement with CABG via left thoracotomy. Replaced synthetic graft and bypass grafts were patent on the postoperative CT. He was discharged at 15th postoperative day with no morbidity.
