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Minimally Invasive Redo Coronary Bypass from the Descending Thoracic Aorta to the Obtuse Marginal Artery

Monday, April 20, 2015

Redo vascularization of a severely stenosed graft is considered risky because of the likelihood of embolization. The authors present a video of a severely stenosed and tortuous graft, redone via saphenous vein graft from the descending thoracic aorta to the obtuse marginal artery. A minimally invasive approach was used.

The surgical approach involved harvesting the saphenous vein in a usual fashion and loading it on the cardiac PAS-port anastomosis device. Left thoracotomy was performed, with the patient in the full lateral position, in order to expose the descending thoracic aorta and the heart. No displacement of the heart was necessary to access the lateral wall. The aorta was examined by transesophageal echocardiogram (TEE), and appeared disease free. The lung was deflated and retracted superiorly. A suitable spot in the descending aorta was selected, and the PAS-port device was fired.

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sorry but the coronary angiogram shown in your presentation demonstrates severe native vessel OM disease both proximal and distal to the old SVG- OM anastomosis. Placing the new SVG bypass onto the old SVG will not lead to complete revascularization. Was the surgical case different from the patients angio depicted in the introduction?
Thanks for the nice video and technique presented here. But, I agree with the comment written above. Angiography shows stenosis at the place of anastomosis and below.The technique is presented to place new SVG graft to old SVG 1-1.5cm higher. and the point? Anyway the thank you for the excellent technique for re-do cases.
In some views it looks like a sequential SVG to OM1-OM2 and the stenosis is past the first anastomosis. This patient has very small coronaries with multifocal diffuse disease. Maybe he will need TMR in the future!!!! Great video.
I have used this technique in redos since 2000 and have done multiple grafts using veins and,radial artery as well on beating heart with minimal dissection just exposing the target vessels.I have also used Lima Radial Y in few redo cases and have have carried out complete revascularisation

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