Redo CABG Using Lateral Minimally Invasive Direct Coronary Artery Bypass Technique -Selection of Grafts, Bypass Inflow and Bypass Routes-

(Department of Surgery III, Nara Medical University, Kashihara, Japan)

Yoshihiro Hayata Tetsuji Kawata Hidehito Sakaguchi
Nobuoki Tabayashi Yoshiro Yoshikawa Shigeo Nagasaka
Takashi Ueda Takehisa Abe Kozo Morita
Shigeki Taniguchi
We performed redo coronary artery bypass grafting (CABG) using lateral MIDCAB for 3 patients with severe symptomatic ischemia in the left circumflex system alone. When the descending thoracic aorta had no atherosclerotic lesions on chest CT, it was selected as the inflow of the bypass. According to the location of the target artery, we undertook sequential or T-composite off-pump bypass using the radial artery through a left lateral thoracotomy. On the other hand, when the descending aorta was diseased, the left axillary artery was chosen as the inflow of the bypass. We selected the saphenous vein as a conduit to obtain sufficient graft length. A proximal anastomosis was made through a left infraclavicular incision, and then a distal anastomosis was done through a left lateral thoracotomy without cardiopulmonary bypass. Moreover, care was taken not to kink the grafts. The postoperative course was uneventful in all patients. Lateral MIDCAB technique was useful for redo revascularization to the circumflex system. We believe that selection of bypass conduits, routes, and bypass inflow according to the individual patient is essential for the procedure.
@Jpn. J. Cardiovasc. Surg. 32: 318 -321 (2003)