RESUMO
In poststernotomy redo cardiac surgery, injury to cardiac structures during sternal division can lead to untoward results in the operation. These days, Minimally Invasive Cardiac Surgery (MICS) such as the right anterolateral thoracotomy approach is becoming popular. By using MICS technique in redo cardiac surgery, it may be possible to reduce the risk of injury to the vital structures because of avoiding full sternotomy with the reduction of the dissection area. Six redo cardiac surgery cases in which innominate vein or bypass graft was in close contact with the sternum were is considered difficult to perform via the right thoracotomy approach. We report the cases in which operations were safely conducted through the lower hemi-sternotomy.
RESUMO
Late acute type A aortic dissection after coronary artery bypass grafting (CABG) is rare, and only a few cases have been published in the literature. It is important to treat cases of living graft during reoperation. We report a successful surgical treatment in a case of late acute type A aortic dissection after CABG. A 68-year-old man underwent a triple CABG (to the left anterior descending artery with left internal thoracic artery, to the left circumflex artery with left radial artery, and to the right coronary artery with right gastroepiploic artery) beating heart procedure using a centrifugal pump and pulmonary assist with closed circuit due to unstable angina pectoris in December 2007 and had presented with sudden anterior chest pain, and was found to have an ascending aortic dissection (type A) on enhanced computed tomography in May, 2009. We performed ascending artery replacement, paying special attention to the living graft performed through a median sternotomy. The postoperative course was uneventful and he was discharged on the 22nd postoperative day.