AI Article Synopsis
- Median sternotomy is the standard method for coronary artery bypass grafting, but in some high-risk cases, alternative approaches may be necessary.
- The authors describe a case of off-pump coronary artery bypass grafting performed through left anterior thoracotomy in a patient with unstable angina and a complicated medical history, specifically total laryngectomy and tracheostoma.
- By modifying the surgical technique to extend the incision and resect certain ribs, they successfully accessed the heart without converting to median sternotomy, suggesting this approach could be a viable option for similar patients at risk for surgical complications.
Article Abstract
Median sternotomy is the standard approach for coronary artery bypass grafting. Herein, we performed off-pump coronary artery bypass grafting via left anterior thoracotomy from the 4th costal space in an unstable angina pectoris patient with total laryngectomy and a permanent tracheostoma. In this patient, median sternotomy had high risks of surgical-site infection and tracheal injury. To avoid these risks, we selected left anterior thoracotomy. Initially, it was difficult to expose the ascending aorta and postdescending branch. With extension of the skin incision to the median area and division of the 5th and 6th ribs and costal arch, we could expose the anastomotic sites, including the ascending aorta and postdescending branch, without median sternotomy conversion. We performed multiple coronary artery bypass graft procedures safely. This approach might be an additional surgical option in patients with total laryngectomy and a permanent tracheostoma.
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| http://dx.doi.org/10.1007/s11748-019-01143-1 | DOI Listing |
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