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Redo endoscopic assisted coronary artery bypass grafting in an 86-year-old patient: a case report and technical
Aryian Naghashzadegan1, Abdullah Kaya1
1Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium.
Insights
Redo coronary artery bypass grafting (CABG) using minimally invasive endoscopic techniques avoids sternotomy, reducing risks and improving recovery. This approach offers a safe alternative for patients needing repeat cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Surgery
- Thoracic Surgery
Background:
- Redo cardiac surgery after sternotomy poses risks like injury and hemorrhage.
- Prior sternotomy complicates repeat sternal re-entry and mediastinal dissection.
- Coronary artery bypass grafting (CABG) is a common cardiac procedure.
Purpose of the Study:
- To evaluate the feasibility and safety of endoscopically assisted CABG in a patient with prior sternotomy.
- To demonstrate a minimally invasive approach for revascularization in complex redo CABG cases.
Main Methods:
- The patient underwent thoracoscopic adhesiolysis and internal mammary artery harvesting.
- Coronary anastomosis was performed via a limited left thoracotomy.
- Femoral cardiopulmonary bypass was utilized for extracorporeal circulation.
Main Results:
- The endoscopically assisted redo CABG was successfully completed.
- The patient experienced an uneventful recovery and was discharged on postoperative day six.
- One-month follow-up showed the patient remained asymptomatic with preserved ventricular function.
Conclusions:
- Endoscopically assisted CABG is a safe and feasible option for selected patients requiring repeat surgery.
- This minimally invasive technique reduces surgical trauma and facilitates faster patient recovery.
- It offers an alternative to traditional sternotomy in redo cardiac procedures.
Abstract:
Redo cardiac surgery following a prior sternotomy presents significant technical challenges and increased risks due to potential injuries during sternal re-entry, mediastinal adhesions and hemorrhage. Endoscopically assisted coronary artery bypass grafting (CABG) offers a minimally invasive alternative approach, avoiding sternotomy while achieving complete revascularization and reducing operative morbidity. An 86-year-old male with prior CABG in 2011 who presented with recurrent angina due to graft occlusion and a circumflex lesion unsuitable for intervention. Revascularization was performed using thoracoscopic adhesiolysis and internal mammary harvesting, followed by a hand-sewn coronary anastomosis through a limited left thoracotomy under femoral cardiopulmonary bypass. The patient recovered uneventfully and was discharged on postoperative day 6. At one-month follow-up, he remained asymptomatic with preserved ventricular function. Endoscopically assisted coronary bypass grafting is a safe and feasible alternative in selected patients while reducing surgical trauma and allowing rapid recovery.
