Redo Coronary Revascularization Using Off-Pump Axillo-Coronary Artery Bypass Grafting

(Department of Thoracic and Cardiovascular Surgery, Hokkaido Prefectural Kushiro Hospital, Kushiro, Japan and Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine*, Sapporo, Japan)

Yoshikazu Hachiro Hideyuki Harada Toshio Baba
Yukiko Honma Tomio Abe*
We describe two patients who underwent repeat off-pump coronary revascularization by axillo-coronary artery bypass grafting. A 63-year-old man (case 1), who had undergone coronary artery bypass grafting (CABG) 13 years previously, was admitted to our hospital with exertional angina. The saphenous vein grafts (SVG) to the left anterior descending artery (LAD), circumflex artery (Cx), and right coronary artery (RCA) all were occluded. The left internal thoracic artery (LITA) also was occluded because it had been injured. Because the patient declined to undergo a redo CABG, percutaneous transluminal coronary angioplasty (PTCA) to the LAD was attempted. However, coronary dissection occurred, and an emergency operation was performed. A 66-year-old man (case 2), who had undergone CABG 12 years previously, was admitted with unstable angina. The LITA to the LAD and the SVG to the RCA were occluded. The SVG to the Cx had 99% stenosis in its mid-portion and was the cause of the angina. PTCA and stenting of this SVG were performed. Two weeks later, an operation was done. In both patients, the left axillary artery was selected as the site of the proximal anastomosis. Both patients underwent off-pump bypass grafting to the LAD from the left axillary artery using a SVG. Both grafts were patent postoperatively. This approach resulted in early symptomatic improvement.
@Jpn. J. Cardiovasc. Surg. 32F175 -177 (2003)