Off-pump coronary artery bypass grafting via left anterior thoracotomy from the 4th costal space in a patient with total laryngectomy and a permanent tracheostoma

• Published in: General thoracic and cardiovascular surgery Vol. 68; no. 6; pp. 633 - 636
• Main Authors: Akiyoshi, Kei, Mamoru, Arakawa, Makino, Jun, Nakamura, Noriyuki, Shinshi, Mio, Nakata, Hiroko, Adachi, Koichi
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.06.2020; Springer Nature B.V
• Subjects: Angina pectoris; Cardiac Surgery; Cardiology; Case Report; Coronary vessels; Electrocardiography; Emergency medical care; Heart surgery; Medical imaging; Medicine; Medicine & Public Health; Ostomy; Patients; Rib cage; Surgical Oncology; Sutures; Thoracic Surgery; Veins & arteries; United States > US; Total laryngectomy; Off-pump coronary artery bypass grafting; Permanent tracheostoma; Left anterior thoracotomy
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-019-01143-1

Median sternotomy is the standard approach for coronary artery bypass grafting. Herein, we performed off-pump coronary artery bypass grafting via left anterior thoracotomy from the 4th costal space in an unstable angina pectoris patient with total laryngectomy and a permanent tracheostoma. In this patient, median sternotomy had high risks of surgical-site infection and tracheal injury. To avoid these risks, we selected left anterior thoracotomy. Initially, it was difficult to expose the ascending aorta and postdescending branch. With extension of the skin incision to the median area and division of the 5th and 6th ribs and costal arch, we could expose the anastomotic sites, including the ascending aorta and postdescending branch, without median sternotomy conversion. We performed multiple coronary artery bypass graft procedures safely. This approach might be an additional surgical option in patients with total laryngectomy and a permanent tracheostoma.