The Effective Use of Redo of Off-Pump Coronary Artery Bypass Grafting through a Left Thoracotomy with a Patent Left Internal Thoracic Artery Graft
10.4326/jjcvs.35.85
- VernacularTitle:左内胸動脈（ＬＩＴＡ）開存例の不安定狭心症に対して左開胸下ＯＰＣＡＢが有用であった再手術の１例
- Author:
Atsutomo Morishima
;
Nozomu Sasahashi
;
Kouji Ueyama
- Publication Type:Journal Article
- Keywords:
OPCAB;
RCA
- From:Japanese Journal of Cardiovascular Surgery
2006;35(2):85-88
- CountryJapan
- Language:Japanese
-
Abstract:
Redo of off-pump coronary artery bypass grafting (CABG) through a left thoracotomy with a patent left internal thoracic artery graft was very effective. A 62-year-old man was admitted because of unstable angina for whom CABG had been performed 6 years earlier (LITA-LAD, Ao-SVG-OM1), the saphenous vein graft soon become occluded. Coronary angiography revealed total occlusion of the right coronary artery (RCA)#1. For vasoconstruction of the left circumflex artery (LCx) and RCA, off-pump coronary artery bypass (OPCAB) was performed through a left thoracotomy. During normal cardiac contraction, a radial artery graft (RAG) was anastomosed sequentially from the descending aorta to the obtuse margin (OM) 1, OM2, RCA#4PL (postero-lateral branch). The postoperative course was uneventful and he was discharged on the 26th post-operative day. In patients with patent grafts, re-median sternotomy has a high risk of injury to already patent grafts and adhesions make the dissection difficult. Alternatively, as in this case, off-pump coronary artery bypass through a left thoracotomy can be very effective. Total arterial vasoconstruction was performed and postoperatively there was no early graft occlusion.
