Minimally Invasive Redo-Coronary Artery Bypass Grafting to the Left Anterior Descending Artery
Luke J Rogers1, Mohammad Reza Rezaei1, Piroze M Davierwala1
1Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Insights
Reoperation in cardiac surgery poses risks due to adhered structures. This case study presents a minimally invasive approach for arterial revascularization, avoiding resternotomy and cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Cardiac Reoperation
Background:
- Reoperation in cardiac surgery is linked to higher morbidity and mortality rates.
- Adherence of cardiovascular structures to the sternum increases risk during reoperation.
- Previous coronary artery bypass graft surgery can complicate subsequent cardiac procedures.
Observation:
- A 71-year-old male presented with severe exertional angina post-coronary artery bypass graft.
- Coronary angiography revealed occluded grafts (left internal thoracic artery and saphenous vein).
- CT scan showed the right ventricle and pulmonary artery adhered to the sternum.
Findings:
- A minimally invasive strategy was employed for arterial revascularization of the left anterior descending artery.
- This approach successfully avoided high-risk resternotomy.
- The procedure also circumvented the need for cardiopulmonary bypass and aortic manipulation.
Implications:
- Minimally invasive techniques can offer a safer alternative for complex cardiac reoperations.
- Careful pre-operative imaging is crucial for planning in patients with adhered structures.
- This approach may reduce operative risks and improve outcomes in selected reoperative cardiac surgery patients.
Abstract:
Reoperation in cardiac surgery is associated with increased morbidity and mortality. The proximity of cardiovascular structures such as the right ventricle, aorta, and/or grafts to the posterior table of the sternum increases the risk of inadvertent injury. Here, we present the case of a 71-year-old gentleman who was admitted with exertional angina (Canadian Cardiovascular Society III/IV) following coronary artery bypass graft over 30 years ago. Coronary angiogram demonstrated an atretic chronically occluded left internal thoracic artery graft and an acutely occluded saphenous vein graft, and computed tomography revealed that the right ventricle and pulmonary artery were closely adherent to the posterior table of the sternum. We outline a minimally invasive approach to ensure arterial revascularization of the left anterior descending artery while avoiding high-risk resternotomy, cardiopulmonary bypass, and aortic manipulation.
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