| 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 |
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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) |
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