Unai Shinya, Cook Gary, Hirose Hitoshi, Cavarocchi Nicholas, Entwistle John
Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Heart Surg Forum. 2014 Apr;17(2):E77-9. doi: 10.1532/HSF98.2013308.
An 83-year-old male with a history of three prior sternotomies, including coronary artery bypass surgery (CABG), presented with unstable angina. Cardiac catheterization showed left main and triple-vessel disease. The saphenous vein graft (SVG) to the right coronary artery was diseased but patent, and the SVG to the left anterior descending artery (LAD) was occluded. Preoperative evaluation showed a heavily calcified ascending aorta and minimum disease on the descending aorta. He successfully underwent a left thoracotomy 2-vessel off-pump CABG using the descending aorta for the proximal anastomosis. The left thoracotomy approach is a useful alternative to avoid complications associated with resternotomy, especially in patients with a hostile chest, although visualization of the target vessels may be limited.
一名83岁男性，既往有三次胸骨切开术史，包括冠状动脉旁路移植术（CABG），现出现不稳定型心绞痛。心脏导管检查显示左主干和三支血管病变。右冠状动脉的大隐静脉移植血管（SVG）有病变但通畅，左前降支动脉（LAD）的SVG闭塞。术前评估显示升主动脉严重钙化，降主动脉病变轻微。他成功接受了左胸两血管非体外循环CABG，使用降主动脉进行近端吻合。左胸入路是避免再次胸骨切开术相关并发症的一种有用替代方法，特别是对于胸部情况不佳的患者，尽管目标血管的可视化可能有限。
