Two-vessel off-pump coronary artery bypass grafting by left thoracotomy in a complex reoperative case

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Surgery

Background:

• An 83-year-old male with unstable angina and complex coronary artery disease, including left main and triple-vessel disease, presented for surgical intervention.
• The patient had a history of three prior sternotomies and patent but diseased saphenous vein grafts (SVG), with one occluded SVG to the left anterior descending artery (LAD).
• Preoperative assessment revealed a heavily calcified ascending aorta, posing significant risks for repeat sternotomy.

Observation:

• The patient underwent a successful off-pump coronary artery bypass grafting (CABG) procedure.
• The surgical approach utilized was a left thoracotomy, bypassing the need for resternotomy.
• The descending aorta was used for the proximal anastomosis during the procedure.

Findings:

• The left thoracotomy approach facilitated a 2-vessel off-pump CABG in a patient with a "hostile chest" due to previous sternotomies.
• This minimally invasive technique successfully revascularized the target coronary arteries.
• The procedure avoided the potential complications associated with a fourth sternotomy.

Implications:

• The left thoracotomy offers a viable alternative surgical strategy for patients with complex coronary artery disease and multiple prior sternotomies.
• This approach may reduce morbidity and mortality in high-risk surgical candidates.
• Further research can explore the broader applicability and long-term outcomes of thoracotomy-based CABG in selected patient populations.