Redo Off-Pump Coronary Bypass Surgery via Left Thoracotomy

This 73 year old lady had a coronary bypass surgery procedure 10 years ago at which she had five bypass grafts constructed. She had been well and symptom-free until 3 months ago when she developed worsening angina, breathlessness and fatigue. Repeat coronary angiography showed four patent grafts to the left anterior descending artery, diagonal artery and two grafts to the right coronary system. However a radial graft to the large and single obtuse marginal branch of the circumflex artery was occluded. An attempt to stent the native left main and circumflex coronary artery was unsuccessful due to severe calcification of the left main coronary artery. She was referred for redo CABG. Surgical options available were repeat sternotomy or left thoracotomy. The latter option was selected as it was potentially less invasive than the former option. Surgery was uncomplicated. A 6th intercostal space left postero-lateral thoracotomy was made. It was performed off-pump with a single vein graft placed from the descending thoracic aorta to the obtuse marginal artery just distal to the previously constructed radial anastomosis. The radial graft was seen at surgery and was atretic and small. The patient made an uncomplicated recovery. Video is obtained using head-mounted Parallel Medical Camera : www.parallel-medical.com.