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Updated: Sep 3, 2025
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
[Coronary Artery Bypass Grafting via Partial Sternotomy Late after Partial Chest Wall Resection:Report of a Case]
Kosuke Nakata1, Jun Takaki, Kosaku Nishigawa
1Department of Cardiovascular Surgery, Kumamoto University, Kumamoto, Japan.
Insights
A 74-year-old man with severe triple vessel disease underwent successful off-pump coronary artery bypass grafting (CABG). This complex case involved prior chest wall resection and reconstruction, presenting unique surgical challenges.
Area of Science:
- Cardiovascular Surgery
- Thoracic Oncology Reconstruction
Background:
- Patient history includes fibrosarcoma treated with chest wall resection (right clavicle, first/second ribs) 40 years prior.
- Right internal thoracic artery was resected during initial surgery; chest wall reconstruction plate removed 29 years later due to infection.
Observation:
- Severe triple vessel disease necessitating coronary artery bypass grafting (CABG).
- Previous extensive chest wall surgery and reconstruction impacting surgical approach.
Findings:
- Successful off-pump CABG achieved complete revascularization.
- Utilized left internal thoracic artery and vein grafts with a lower partial sternotomy.
- Managed risks of sternum dehiscence and mediastinitis due to compromised blood flow.
Implications:
- Demonstrates feasibility of complex CABG in patients with significant prior thoracic surgery.
- Highlights the importance of tailored surgical strategies for sternal integrity and infection prevention.
- Offers insights into managing cardiovascular disease in patients with a history of extensive chest wall reconstruction.
Abstract:
A 74-year-old man was referred to our department to receive coronary artery bypass grafting (CABG) because of severe triple vessel disease. He had undergone a chest wall resection including the right clavicle and the first and second ribs for the fibrosarcoma 40 years ago. The right internal thoracic artery was resected at the operation. Twenty-nine years after the operation, the plate used for the reconstruction of the chest wall was removed because of its infection. Off-pump CABG using left internal thoracic artery and vein grafts with lower partial sternotomy was successfully performed for the complete revascularization. This patient had a high possibility of sternum dehiscence and postoperative mediastinitis due to poor blood flow in the right upper sternum.
