Minimally Invasive Redo Coronary Bypass from the Descending Thoracic Aorta to the Obtuse Marginal Artery

Redo vascularization of a severely stenosed graft is considered risky because of the likelihood of embolization. The authors present a video of a severely stenosed and tortuous graft, redone via saphenous vein graft from the descending thoracic aorta to the obtuse marginal artery. A minimally invasive approach was used.

The surgical approach involved harvesting the saphenous vein in a usual fashion and loading it on the cardiac PAS-port anastomosis device. Left thoracotomy was performed, with the patient in the full lateral position, in order to expose the descending thoracic aorta and the heart. No displacement of the heart was necessary to access the lateral wall. The aorta was examined by transesophageal echocardiogram (TEE), and appeared disease free. The lung was deflated and retracted superiorly. A suitable spot in the descending aorta was selected, and the PAS-port device was fired.

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