Double Off-Pump Coronary Artery Bypass Surgery via Lateral Thorocotomy in a Case with Pre-sternal Reconstruction after Esophageal Cancer Resection

(Department of Cardiovascular Surgery, Hiratsuka Kyosai Heart Center, Hiratsuka Kyosai Hospital, Hiratsuka, Japan, and Present address:Department of Cardiovascular Surgery, Odawara Municipal Hospital, Odawara, Japan)

Toshihiro Ishikawa Kazuyoshi Hatada Takemi Handa
Keisuke Miyajima Masao Takahashi
A 71-year-old man with double vessel disease(left anterior descending artery and right coronary artery)was surgically treated by off-pump coronary artery bypass grafting. He had undergone pre-sternal subcutaneous gastric tube reconstruction and mediastinal radiation therapy 19 years previously due to esophageal cancer. The gastric tube prevented the median sternotomy that is commonly necessary for cardiac surgery. In cases with difficulties of median sternotomy, left anterolateral thoracotomy and the use of the subclavian artery as inflow root for bypass grafting are available. Both radial arteries were harvested as graft conduit, because of prospective severe adhesion of left internal thoracic artery due to previous radiation. The radial artery was anastomosed on the back side of the left subclavian artery with side-to-end fashion. Y-shaped composite graft was made with the other arterial graft. Both ends were anastomosed to the left anterior descending artery and the right posterior descending branch on the beating heart status without cardiopulmonary bypass. Intra-operative SPY images showed good patency of both bypass grafts. The post-operative course was eventful. The catheter angiography revealed all graft patency 5 years after the surgery.
  Jpn. J. Cardiovasc. Surg. 42:316-319(2013)

Keywords:off-pump CABG, multiple bypass grafting, esophageal cancer, pre-sternal reconstruction, post radiation therapy