Back to 2024 Display ePosters
Minimally Invasive Redo Coronary Artery Bypass Grafting Using Right Gastro-epiploic Artery To Pda
Chidiebere Peter Echieh, Yash Rohila, Abel Cherian, Alex Ryan, Kevin Wang, Toshinobu Kazui;
University of Arizona, Tucson, AZ, USA
Objective: A redo coronary artery bypass grafting (CABG) with patent grafts adds complexity to the redo surgery. In the setting of multiple failed repeat percutaneous coronary interventions in previous CABG, redo CABG may be indicated. We performed minimally invasive redo CABG to the posterior descending artery (PDA) with the gastroepiploic artery (GEA).
Case presentation A 57-year-old male with dyslipidemia, diabetic peripheral neurovascular disease, and end-stage renal disease on peritoneal dialysis presented with non-ST elevation myocardial infarction (NSTEMI). He had a history of CABG [left internal mammary artery (LIMA) to left anterior descending artery (LAD), saphenous vein graft (SVG) to obtuse marginal 2 (OM2)] 2.5 years ago. He also had two previous percutaneous coronary interventions (PCI) on the right coronary artery (RCA), with stents inserted into the proximal and mid-RCA. Coronary angiography demonstrated patent previous grafts (LIMA to LAD and SVG to OM2). The mid-RCA had diffused in-stent restenosis with 99% occlusion and severe calcification. Given his history of multiple PCI to the RCA with significant calcification, we decided to proceed with a minimally invasive redo CABG with GEA. We approached via sub-xyphoid. We harvested the right GEA using a harmonic scalpel in a skeletonized fashion. The diaphragm and the pericardium were incised. The diaphragmatic surface of the heart was dissected. An off-pump retractor was placed on the abdominal wound. The Octopus stabilizer was used to expose the PDA. We used ultrasound to identify the optimal site for the anastomosis. Anastomosis of right GEA to PDA was performed in end-to-side fashion. Postoperative recovery was uneventful. The patient was discharged on postoperative day 4.
Conclusion: To treat RCA stenosis in patients with previous CABG and patent grafts, minimally invasive redo CABG utilizing GEA can be a good option to minimize surgical trauma and potential injury of patent grafts.
Back to 2024 Display ePosters
