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[A case of MIDCAB to the left circumflex via the left posterolateral thoracotomy]
Y Okamura1, Y Mochizuki, H Iida
1Department of Cardiothoracic Surgery, Dokkyo University School of Medicine, Tochigi, Japan.
Insights
This study details a successful minimally invasive direct coronary artery bypass (MIDCAB) reoperation for circumflex artery grafting using a posterolateral thoracotomy. The procedure preserved existing grafts and achieved excellent outcomes, offering a viable alternative for complex cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- Minimally invasive direct coronary artery bypass (MIDCAB) has been reported for left anterior descending artery revascularization.
- Graft failure, such as saphenous vein graft (SVG) occlusion, can necessitate repeat interventions or reoperation.
Observation:
- A 66-year-old male patient with a history of prior CABG required reoperation due to SVG occlusion.
- A left posterolateral thoracotomy approach was chosen for MIDCAB to the circumflex artery to preserve the patent left internal thoracic artery (LITA) graft to the left anterior descending (LAD) artery.
- Specialized instruments including a rib retractor, stabilizer, and CO2 blower facilitated a bloodless and stable surgical field.
Findings:
- The reoperation successfully utilized a new SVG for bypass to the circumflex artery.
- The procedure was completed without complications, blood transfusion, or damage to the existing LITA graft.
- Postoperative angiography confirmed excellent graft patency, and the patient was discharged after a two-week hospital stay.
Implications:
- Posterolateral thoracotomy MIDCAB is a feasible and effective approach for CABG reoperation on the circumflex artery.
- This technique offers a valuable option for patients with failed grafts requiring repeat bypass surgery while preserving vital existing grafts.
- The use of specialized instruments enhances surgical precision and outcomes in minimally invasive cardiac reoperations.
Abstract:
There have been many reports of MIDCAB to left anterior descending artery via a small dissection utilizing the left anterolateral thoracotomy. We report here a case of CABG reoperation to the circumflex artery by MIDCAB via the left posterolateral thoracotomy. A 66-year-old male patient had received a 3 branch bypass graft on the LITA-LAD and the SVG-OM-4 PD at another institution. Postoperative angiography revealed a SVG occlusion. Since repeated intervention was unsuccessful, reoperation was necessary. To preserve the patency of the LITA, the 4th left intercostal posterolateral thoracotomy was selected. We utilized a commercially available rib retractor for MIDCAB, as well as a stabilizer and a CO2 blower to obtain a nearly perfect bloodless stabilized view. A new SVG was used to connect the left circumflex artery. The operation was successful without any postoperative complications or need for transfusion. After a two week hospital stay, the graft patency was confirmed and the patient was discharged.