The patient was a 49-year-old woman. When she was 39 years old, she underwent coronary artery bypass grafting (left internal thoracic artery to left anterior descending artery, saphenous vein graft to first diagonal branch). At the age 48, she had effort angina. On coronary angiography, triple-vessel disease was found, and she was treated conservatively. Progression of the disease was confirmed with detection of the left circumflex artery associated with jeopardized collateral to the right coronary artery showing total occlusion. The patient underwent reoperation. Since the left internal thoracic artery was patent despite occlusion of the sapheneous vein graft, the approach of left thoracotomy was employed. Under cardiopulmonary bypass with ventricular fibrillation and left vent through left atrial appendage, the right radial artery was anastomosed to the left circumflex artery from the descending thoracic aorta, and the right gastroepiploic artery was anastomosed to the right coronary artery (4AV branch). Patency of the bypass was confirmed postoperatively. We consider this operative technique was especially useful for reoperation in cases of a patent internal thoracic artery in which left thoracotomy can be conducted safely.
reoperation CABG left thoracotomy
This is a preview of subscription content, log in to check access.
Lytle BW, McElroy D, McCarthy P, Loop FD, Taylor PC, Goormastic M, et al. Influence of arterial coronary bypass grafts on the mortality in coronary reoperations. J Thorac Cardiovasc Surg 1994; 107: 675–83.PubMedGoogle Scholar
Fanning WJ, Kakos GS, Williams TE Jr. Reoperative coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 1993; 55: 486–9.PubMedCrossRefGoogle Scholar
Burlingame MW, Bonchek LI, Vazales BE. Left thoracotomy for reoperative coronary bypass. J Thorac Cardiovasc Surg 1988; 95: 508–10.PubMedGoogle Scholar
Ungerleider RM, Mills NL, Wechsler AS. Left thoracotomy for reoperative coronary bypass procedures. Ann Thorac Surg 1985; 40: 11–5.PubMedCrossRefGoogle Scholar
Gandjbakhch I, Acar C, Cabrol C. Left thoracotomy approach for coronary artery bypass grafting in patients with pericardial adhesion. Ann Thorac Surg 1989; 48: 871–3.PubMedCrossRefGoogle Scholar
Cheung D, Flemma RJ, Mullen DC, Lepley D Jr. An alternative approach to isolated circumflex coronary bypass reoperations. Ann Thorac Surg 1982; 33: 302–3.PubMedCrossRefGoogle Scholar
Walker WS, Sang CTM. Avoidance of patent anterior grafts at revisional coronary artery surgery: use of a lateral thoracotomy approach. Thorax 1986; 41: 692–5.PubMedCrossRefGoogle Scholar
Suma H, Kigawa I, Horii T, Tanaka J, Fukuda S, Wanibuchi Y. Coronary artery reoperation through the left thoracotomy with hypothermic circulatory arrest. Ann Thorac Surg 1995; 60: 1063–6.PubMedCrossRefGoogle Scholar
Faro RS, Javid H, Najafi H, Serry C. Left thoracotomy for reoperation for coronary revascularization. J Thorac Cardiovasc Surg 1982; 84: 453–5.PubMedGoogle Scholar