Minimally Invasive Direct Coronary Artery Bypass with an Axillo-Left Anterior Descending Vein Graft

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Abstract

Single-vessel coronary bypass grafting with left internal mammary artery to the left anterior descending coronary artery has been extensively demonstrated to produce excellent long-term results. New minimally invasive direct coronary artery bypass procedures are being developed to retain the benefits of internal mammary artery grafting and to offset the invasiveness of conventional coronary artery bypass grafting. Some clinical situations make impossible to use internal mammary artery for left anterior descending coronary artery revascularization. In our experience with minimally invasive direct coronary artery bypass we treated a 74-year-old male with a prior coronary artery bypass grafting where internal mammary artery had been previously used to bypass a diagonal artery. At reoperation we used an axillo-left anterior descending coronary artery bypass with saphe-nous vein for treating a new proximal stenosis ofthe left anterior descending coronary artery afterangioplasty failure. An 8-cm left para esternal incision was made and third and fourth cartilages were removed. The pericardium was opened and after the traction sutures were placed, a suitable left anterior descending coronary artery was found. A left subclavicular incision was made to dissect axilary artery and a 15-cm saphenous vein graft was firstly attached to it. The vein was tunneled under the pectoral is major muscle and immediately passed into the thorax after overpassing the second costal cartilage. Finally distal anastomosis on left anterior descending coronary artery was performed. The patient did well and graft patency was demonstrated 30-days after with angiogram and 10-months later with eco-Doppler.