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

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Correspondence

Minimally Invasive Axillary–Coronary Artery Bypass

^a Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba Science City, Ibaraki 305, Japan

To the Editor

I read with great interest the recent article by Knight and associates [1] reporting minimally invasive axillary–coronary artery bypass using a reversed saphenous vein graft (SVG). This approach can be applied to surgical revascularization to the left anterior descending artery when the left internal thoracic artery is not adequate for use. Knight and associates indicated the benefit of this approach, which is easy detection of graft patency using a simple Doppler probe. However, it must be considered that the long-term results of this SVG can be affected by its route. Knight and associates chose the route through a tunnel, created from a subclavicular incision to the site of the resected left fourth costal cartilage, behind the pectoralis major muscle medial to the pectoralis minor muscle. The SVG is crammed between the pectoralis major muscle and the ribs. Direct extrinsic mechanical stress to almost the entire overall length of the SVG from the muscle contraction and respiration in daily life may affect not only graft occlusion in the acute phase but also the progression of long-term vein graft disease [2]. Yaryura and colleagues [3] reported a route tunneled just over the first rib and under the second rib into the pleural space for avoiding a long course of SVG sandwiched between the ribs and muscle. Faro and coworkers [4] performed left subclavian artery-to-left anterior descending artery bypass with an SVG through a fourth intercostal anterolateral thoracotomy. With this approach, the entire course of the SVG is in the thoracic cavity without any possibility of pressure on the SVG from muscles. Further study of this important problem regarding the route of the SVG is necessary.

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. Lee R.T., Loree H.M., Fishbein M.C. High stress regions in saphenous vein bypass graft atherosclerotic lesions. J Am Coll Cardiol 1994;24:1639-1644.[Abstract]
3. Yaryura R., Vardhan R., Springer A.J., Cooley D.A. A 66-year-old-man with severe angina and previous coronary artery bypass. Lancet 1997;349:396.[Medline]
4. Faro R.S., Javid H., Najafi H., Serry C. Left thoracotomy for reoperation for coronary revascularization. J Thorac Cardiovasc Surg 1982;84:453-455.[Medline]

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): Yuzuru Sakakibara Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sakakibara, Y. Search for Related Content PubMed Articles by Sakakibara, Y.