Harvesting left internal thoracic artery via clamshell incision for coronary bypass and lung transplant

Area of Science:

• Cardiothoracic Surgery
• Transplantation Medicine
• Vascular Surgery

Background:

• Concomitant lung transplantation and coronary artery bypass grafting (CABG) are increasingly performed in aging populations.
• The traditional median sternotomy approach is often used for CABG when the internal thoracic artery (ITA) is harvested.
• This approach may present challenges in combined procedures involving lung transplantation.

Purpose of the Study:

• To describe a modified surgical technique for harvesting the left internal thoracic artery (LITA) using a clamshell incision.
• To evaluate the feasibility of this technique in a patient undergoing combined bilateral lung transplant and CABG.
• To offer an alternative surgical approach for complex thoracic procedures.

Main Methods:

• A 71-year-old male with end-stage respiratory failure and coronary artery disease underwent a combined bilateral lung transplant and CABG.
• The left internal thoracic artery (LITA) was harvested using a clamshell incision, providing bilateral thoracic access.
• The harvested LITA was then used for coronary artery bypass grafting.

Main Results:

• The clamshell incision allowed for simultaneous harvesting of the LITA and preparation for bilateral lung transplantation.
• The LITA was successfully harvested and utilized for CABG.
• The combined procedure was completed without reported complications related to the LITA harvesting technique.

Conclusions:

• Harvesting the left internal thoracic artery via a clamshell incision is a feasible technique for combined lung transplantation and coronary artery bypass grafting.
• This approach may offer advantages in complex thoracic surgeries requiring bilateral access.
• The technique provides a valuable alternative for selected patients undergoing combined procedures.