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Ann Thorac Surg 1998;65:1196-1197
© 1998 The Society of Thoracic Surgeons

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Correspondence

Minimally Invasive Axillary–Coronary Artery Bypass

^a Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Japan

To the Editor

We read with interest the article by Knight and associates [1]. They performed axillary–coronary artery bypass using a reversed saphenous vein during minimally invasive direct coronary artery bypass because of an inadequate internal thoracic artery conduit. In their technique, the vein graft was placed behind the pectoralis major, superficial to the ribs, and medial to the pectoralis minor. However, we were concerned that this route might produce pressure on the vein graft from the surrounding muscle and ribs. Therefore, we used a modified version of their technique in such a case.

Chest entry and internal thoracic artery harvesting were performed as previously described [2]. Another short transverse incision was added below the left clavicle when the left internal thoracic artery was found to be inadequate for bypass conduit. Approximately 3 cm of the left axillary artery was exposed by dissection. The saphenous vein was harvested and anastomosed to the left anterior descending artery. After an appropriate intercostal site was chosen caudal to the left axillary artery to be anastomosed, the intrathoracic space was penetrated with a tunneling device. Subsequently, the bypass graft was pulled out through the opening. Proximal anastomosis was performed between the graft and the left axillary artery. Consequently, the bypass conduit was passed through an intrathoracic route.

Of course, as cases of minimally invasive axillary–coronary artery bypass are limited, it would be difficult to definitively conclude which route is better. However, in our opinion, the intrathoracic route has two advantages over the supracostal route: (1) a shorter length of graft is required and (2) as pulmonary expansion creates less pressure on the graft than muscle contraction, the former route affects the patency of graft favorably. In addition, we disagree with the comment by Knight and associates that this technique should also be used if the left internal thoracic artery is too short. In such a condition, as reported by Calafiore and associates [2], a composite conduit technique is preferable because it does not require another transverse incision. Nevertheless, we share Knight and associates’ opinion that this technique may allow extended use of the minimally invasive coronary bypass procedure.

References

1. Knight W.L., Baisden C.E., Reiter C.G. Minimally invasive axillary–coronary artery bypass. Ann Thorac Surg 1997;63:1776-1777.[Abstract/Free Full Text]
2. Calafiore A.M., Di Giammarco G., Teodori G., et al. Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass. Ann Thorac Surg 1996;61:1658-1665.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kiyofumi Morishita Tomio Abe Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Morishita, K. Articles by Abe, T. Search for Related Content PubMed Articles by Morishita, K. Articles by Abe, T.