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[Two cases of minimally invasive reoperative coronary artery bypass]
1Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Shizuoka, Japan.
Insights
Reoperative coronary artery bypass grafting (CABG) using minimally invasive direct coronary artery bypass (MIDCAB) offers a safe alternative. This approach may reduce mortality and improve recovery for patients needing repeat bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Reoperative coronary artery bypass grafting (CABG) carries higher mortality risks than primary CABG.
- Risks include cardiac and graft injury during dissection and sternal reopening.
Observation:
- Two patients with recurrent angina due to old vein graft occlusion underwent reoperative CABG.
- Minimally invasive direct coronary artery bypass (MIDCAB) was performed using the left internal thoracic artery to the LAD via anterolateral thoracotomy without cardiopulmonary bypass.
Findings:
- Both patients experienced rapid recovery.
- Postoperative angiography confirmed widely patent new grafts.
- Patients were discharged within two weeks with near-normal activity levels.
Implications:
- Reoperative MIDCAB grafting shows promise as a safe and effective alternative to traditional reoperative CABG.
- This minimally invasive technique may reduce complications and improve outcomes for patients requiring repeat bypass surgery.
Abstract:
Reoperative coronary artery bypass grafting (CABG) are still associated with higher mortality than primary CABG. This is due in part to the potential for cardiac and patent graft injury during their dissection and the reopening of the sternum. Therefore, in two patients with recurrent angina attributable to occlusion of the old vein graft to the LAD, we performed reoperative CABG by the minimally invasive direct coronary artery bypass (MIDCAB) procedures. The left internal thoracic artery was anastomosed to the LAD through small anterolateral thoracotomy without cardiopulmonary bypass. Both patients recovered fast and underwent postoperative angiogram, showing the new grafts widely patent. About two weeks later, both discharged in the conditions of nearly normal activities. The reoperative MIDCAB grafting might be expected to be as safe and promising as the primary one.