[Two-staged repeat myocardial revascularization through the sternal re-entry and the left thoracotomy with coronary...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology

Background:

• A 56-year-old male with hypertension and hyperlipidemia presented with unstable angina.
• He had a history of primary coronary artery bypass grafting (CABG) using saphenous veins 10 years prior.

Observation:

• The sole patent vein graft to the left anterior descending coronary artery (LAD) showed severe stenosis, supplying all coronary circulation.
• A second surgery via sternal reentry was complicated by adhesions and abscess formation, necessitating a beating-heart anastomosis of the gastroepiploic artery (GEA) to the right coronary artery (RCA) without cardiopulmonary bypass (CPB).
• Recurrent unstable angina occurred despite a patent GEA graft.

Findings:

• A third operation involving left thoracotomy and CPB successfully established a new saphenous vein graft from the descending aorta to the LAD.
• Postoperative angiography confirmed patency of both new grafts.

Implications:

• Serial repeat myocardial revascularization, even under challenging conditions like beating-heart surgery and adhesions, can be effective.
• This case highlights the feasibility of complex, multi-stage revascularization for managing critical coronary artery stenosis in high-risk patients.
• Successful revascularization led to complete symptom relief and good graft patency.