[Left thoracotomy for coronary artery bypass grafting without cardiopulmonary bypass in a patient with porcelain aorta].

Extended calcification of the total aorta and arch vessels may make coronary revascularization with cardiopulmonary bypass impossible. We report the left thoracotomy approach for a case of a 70-years diabetic man who was revascularized without cardiopulmonary bypass because of porcelain aorta extended into abdominal aorta, the arch vessels and femoral arteries. He had had prior anterior wall infarction. Cardiac catheterization showed poor ventricular function with an EF of 25% and there was a 60% occlusion of left main trunk, 90% occlusion of circumflex coronary. Through a left thoracotomy, saphenous vein grafting was performed without cardiopulmonary bypass from the noncalcified left subclavian artery to the circumflex coronary artery. During distal anastomosis, distal perfusion of coronary artery was carried out to support the heart up. Intraoperatively, hemodynamic remained stable with no electrocardiographic change. This technique may offer a practical solution to this problem.