A Case of A-C Bypass via Left Mini-Thoracotomy Using the Great Saphenous Vein for the Right Coronary Artery in Patient with the Gastric Tube Reconstruction via the Retrosternal Route
- VernacularTitle:胸骨後経路胃管再建術後に左小開胸アプローチで右冠動脈領域に大伏在静脈を用いたA-Cバイパスを施行した1例
- Author:
Kusumi NIITSUMA
1
;
Kosuke NAKAMAE
1
;
Kozo MORITA
2
;
Yoshitsugu NAKAMURA
1
;
Hiroshi NIINAMI
2
Author Information
- Keywords: esophageal cancer; gastric tube reconstruction via the retrosternal route; minimally invasive coronary artery bypass grafting; in-stent restenosis; peripheral coronary intervention
- From:Japanese Journal of Cardiovascular Surgery 2025;54(2):64-68
- CountryJapan
- Language:ja
- Abstract: A 73-year-old man, who underwent total esophagectomy and gastric tube reconstruction via the retrosternal route for esophageal cancer 10 years eariler, was referred to our hospital with chest pain. He was suspected of acute coronary syndrome, and coronary artery angiography was performed, showing in-stent restenosis of the proximal site of the right coronary artery, diagnosed as the culprit lesion, and drug-coated ballooning was performed. His symptoms improved, however, the poor expansion of the stent and in-stent stenosis remained, and he was referred to our department for coronary artery bypass surgery. Because the gastric tube was reconstructed just below the sternum and performing sternotomy seemed to be difficult, a left mini-thoracotomy approach using great saphenous vein was planned. Under general anesthesia, an approximately 10-cm skin incision was made on the left fifth rib from the anterior axillary to the midclavicular line, and the chest wall was opened at the fifth and third intercostal spaces from the same skin incision, to secure views of the AV node branch and ascending aorta. First, the great saphenous vein was anastomosed to the ascending aorta from the third intercostal space, using 3.8 mm puncher and Heartstring III (Getinge, Lindholmspiren, Sweden). After that, the graft was guided extrapericardially via the left intrathoracic cavity, and was anastomosed to the AV nodal branch from the fifth intercostal space. The graft blood flow was 48 ml/min. The postoperative course was uneventful and contrast-enhanced CT confirmed the patency of the graft.
