[A case of MIDCAB to the left circumflex via the left posterolateral thoracotomy].

There have been many reports of MIDCAB to left anterior descending artery via a small dissection utilizing the left anterolateral thoracotomy. We report here a case of CABG reoperation to the circumflex artery by MIDCAB via the left posterolateral thoracotomy. A 66-year-old male patient had received a 3 branch bypass graft on the LITA-LAD and the SVG-OM-4 PD at another institution. Postoperative angiography revealed a SVG occlusion. Since repeated intervention was unsuccessful, reoperation was necessary. To preserve the patency of the LITA, the 4th left intercostal posterolateral thoracotomy was selected. We utilized a commercially available rib retractor for MIDCAB, as well as a stabilizer and a CO2 blower to obtain a nearly perfect bloodless stabilized view. A new SVG was used to connect the left circumflex artery. The operation was successful without any postoperative complications or need for transfusion. After a two week hospital stay, the graft patency was confirmed and the patient was discharged.