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[Urgent coronary reoperation under the beating heart via the left thoracotomy]
Y Okamura1, Y Mochizuki, H Iida
1Department of Cardiothoracic Surgery, Dokkyo University School of Medicine, Tochigi, Japan.
Insights
This case study details a successful repeat coronary artery bypass grafting (CABG) in an elderly patient with unstable angina due to occluded vein grafts. A novel surgical approach achieved symptom relief, demonstrating a viable option for complex revascularization.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- Graft occlusion, particularly in vein grafts, can lead to recurrent angina and necessitates reintervention.
- Complex aortic calcification and previous CABG present significant challenges for repeat revascularization.
Abstract:
An 80-year-old female, who had received coronary artery bypass grafting (CABG) 12 years ago was admitted to our hospital because of unstable angina. The vein grafts to the left anterior descending artery (LAD) and circumflex artery (Cx) were both occluded. Chest computerized tomography showed a severely calcified aorta. An intra-aortic balloon pump was inserted and an urgent reoperation was performed. The patient was positioned for an anterolateral left thoracotomy. The chest was entered through the forth intercostal space. The pericardium was opened parallel to the phrenic nerve. Femorofemoral bypass was instituted. Anastomosis of the saphenous vein graft and the diagonal branch and anastomosis of a second saphenous vein to the old SVG just proximal to the anastomotic site of Cx were performed under a beating heart. Proximal anastomosis of the two saphenous veins and the left subclavian artery was then performed. The patient had an uncomplicated postoperative recovery. A postoperative angiogram showed that the new SVG anastomosed to the diagonal branch was patent while the other new SVG anastomosed to the old SVG/Cx was occluded. The patient was discharged and is now free from angina.