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A Murine Model of Myocardial Ischemia-reperfusion Injury through Ligation of the Left Anterior Descending Artery
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'Thinking outside the sternum' in redo CABG: radial artery from descending aorta to obtuse marginal branch

Francesco Cabrucci1,2, Akshaj Darbar3, Alexander White4

  • 1Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

Multimedia Manual of Cardiothoracic Surgery : MMCTS
|February 12, 2026
PubMed

Insights

Redo coronary artery bypass grafting (CABG) can be complex. This video demonstrates a safe alternative using a left thoracotomy approach for off-pump revascularization, avoiding sternotomy risks.

Area of Science:

  • Cardiac Surgery
  • Minimally Invasive Cardiac Surgery
  • Vascular Surgery

Background:

  • Redo coronary artery bypass grafting (CABG) presents significant surgical challenges.
  • Dense adhesions and risk of injury to cardiac structures and grafts increase complexity.
  • Sternotomy in redo CABG can lead to catastrophic complications, especially with adhesions.

Purpose of the Study:

  • To present a video tutorial of an alternative surgical technique for redo CABG.
  • To demonstrate the safety and reproducibility of off-pump revascularization via left thoracotomy.
  • To provide practical guidance for experienced cardiac surgical teams.

Main Methods:

  • A 77-year-old male with prior CABG underwent off-pump revascularization.
  • A radial artery graft was used, anastomosed to the descending thoracic aorta.
  • The procedure was performed through a left thoracotomy approach, avoiding resternotomy.

Main Results:

  • Successful off-pump revascularization of the obtuse marginal branch was achieved.
  • The left thoracotomy approach successfully circumvented the risks associated with resternotomy.
  • The technique demonstrated was safe and reproducible for complex redo CABG.

Conclusions:

  • Off-pump revascularization via left thoracotomy is a viable alternative for selected redo CABG patients.
  • This 'thinking outside the sternum' approach enhances safety by avoiding resternotomy.
  • The presented technique can transform high-risk redo CABG into a safer procedure.

Keywords:
Arterial graftingCABGOff-pump CABGRadial arteryRedo cardiac surgeryThoracic aorta

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