title: [Inferior mini-sternotomy for off-pump CABG using bilateral internal thoracic arteries].
abstract: Case 1: A 72-year-old woman with effort angina underwent coronary artery bypass grafting. A preoperative coronary angiogram showed 90% stenosis in the proximal main RCA, and total occlusion in the proximal LAD, distal of which was an area well supplied by collaterals from the RCA. This patient had previously undergone right upper lobectomy due to lung cancer. With a skin incision of 8 cm, the LITA was inserted into the LAD and the RITA was inserted into the mid RCA through an inferior mini-sternotomy while the heart was beating. Case 2: A 69-year-old man with effort angina underwent CABG. A preoperative coronary angiogram showed 90% stenosis in the proximal main RCA, 75% stenosis in the PDA and total occlusion in the proximal LAD, distal of which was an area well supplied by collaterals from the RCA. With a skin incision of 11 cm, the LITA was inserted into the LAD, the RITA into the mid-RCA and the radial artery graft attached to the RITA was grafted to the PDA through an inferior mini-sternotomy while the heart was beating. In both cases, the sternum was not cut transversely in order to prevent injury to the ITAs and pseudo-joint formation. With the use of this technique, exposure of the LAD and RCA was excellent. Postoperative recovery in both patients was uneventful and postoperative angiograms revealed widely patent grafts. This technique was very useful when performing off-pump CABG using bilateral ITAs.
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Women's Medical University, Daini Hospital, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Niinami
authors.forename: Y
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: S
authors.initials: S
authors.lastname: Ichikawa
authors.forename: T
authors.initials: T
authors.lastname: Ban
authors.forename: R
authors.initials: R
authors.lastname: Higashida
authors.forename: Y
authors.initials: Y
authors.lastname: Suda
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D019060:Minimally Invasive Surgical Procedures; D013249:Sternum / Q000601:surgery*