A Case of Coronary Artery Bypass Grafting through the Left Thoracotomy after Substernal Gastric Interposition for Carcinoma of the Esophagus

(Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan)

Yasuyuki Kato Satoru Miyamoto Hirokazu Minamimura
Takumi Ishikawa Tadahiro Murakami Hiroyuki Nishi
Kensuke Ohue Yoshihiro Shimizu
We present here a rare case of coronary artery bypass grafting through a left thoracotomy after substernal gastric interposition for esophageal cancer. A 58-year-old man, who had undergone esophagectomy and substernal gastric interposition 11 years previously, was admitted for cerebral infarction from which he made a good recovery without any complication. At this time, the patient was diagnosed as having coronary artery disease on electrocardiogram. Cardiac catheterization revealed triple vessel disease. Coronary artery bypass grafting to the left anterior descending artery and obtuse marginal branch through a left thoracotomy was performed using a radial artery Y-graft under femorofemoral bypass. The aorta was cross-clamped and the heart was arrested with antegrade cold cardioplegic solution for the distal anastomosis of the left anterior descending artery and the obtuse marginal branch which was embedded within the myocardium. The postoperative angiography showed good coronary flow. Left thoracotomy approach provides a good exposure of the left coronary artery. This approach, therefore, is advocated as an alternative method for cases requiring coronary artery bypass but in which median sternotomy is difficult, such as the present case. The appropriate procedure for the site of thoracotomy, supporting methods, choice of graft, and the site of graft anastomosis should be selected in each patient.
@Jpn. J. Cardiovasc. Surg. 32: 276 -279 (2003)