A Case of MICS-CABG Using the Axillary Artery for the Proximal Inflow Source

Yusuke Kawasaki＊

Tatsuya Ozawa＊

Etsuro Suenaga＊

（Division of Cardiovascular Surgery, Kansai Electric Power Hospital＊, Osaka, Japan）

A 73-years-old male with diabetes mellitus was referred for coronary artery bypass grafting（CABG). Preoperative coronary angiography（CAG）revealed total occlusion of proximal LAD#6, and a large diagonal branch supplied from collateral circulation. Because the patient required early recovery, we planned minimally invasive cardiac surgery（MICS). Preoperative chest CT showed dilatation of the ascending aorta, so the left axillary artery was used as the proximal inflow source for saphenous vein graft（SVG). Under general anesthesia, about an 8cm skin incision was made below the left nipple. The chest was entered through the 4th intercostal space. The left internal thoracic artery（LITA）was harvested using the Harmonic Scalpel in direct vision and thoracoscopy supported vision. SVG was harvested using the endoscopic harvesting technique（EVH). The bypass graft design was in situ LITA-LAD, and left axillary artery-SVG-D1. All coronary targets were directly accessed with the off-pump technique. There were no major postoperative complications. The patient was discharged 5 days after the operation. Postoperative coronary CT revealed all grafts patent. The axillary artery is an alternative inflow source for cases with an untouchable ascending aorta such as dilatation or severe atherosclerotic disease in MICS-CABG.

 

Jpn. J. Cardiovasc. Surg. 50:73-77（2021）

Keywords：MICS-CABG;SAXCAB（Subclavian/Axillary artery to coronary artery bypass）;dilatated ascending aorta