A Successful Case of Redo Off-Pump Coronary Artery Bypass Grafting through a Left Thoracotomy Using PAS・Port System for Proximal Vein Graft Anastomoses

(Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan)

Shingo Mochizuki Tatsuya Nakao Norifumi Shigemoto
Yasushi Kawaue
We performed redo off-pump coronary artery bypass (OPCAB) through a left thoracotomy using a PAS・Port system for proximal vein graft anastomoses for a patient with symptomatic ischemia in the left circumflex system. A 60-year-old man underwent OPCAB (LITA-LAD, RA-4PD) 7 years previously. Coronary angiography revealed a remarkable lesion in the left circumflex system, but the left internal thoracic artery graft (ITAG) and the radial artery graft (RAG) were patent. OPCAB was performed through a left thoracotomy to avoid injury to the patent grafts. With the heart beating, a saphenous vein graft (SVG) was anastomosed sequentially from the descending aorta to the first and second obtuse marginary arteries. Avoiding descending aortic clamping, a proximal anastomosis was made using the PAS・Port system and the SVG was routed anterior to the pulmonary hilum. The postoperative course was uneventful and he was discharged on the 22nd postoperative day. Cardiac CT showed patent SVG and adequate proximal anastomosis. In this case OPCAB through left thoracotomy was effective. The selection of the graft inflow source and bypass routes according to the individual patient is essential for the success of the procedure.
 Jpn. J. Cardiovasc. Surg. 37: 205-208 (2008)