Two-Vessel Off-Pump Coronary Artery Bypass Grafting by Left Thoracotomy in a Complex Reoperative Case

An 83-year-old male with a history of three prior sternotomies, including coronary artery bypass surgery (CABG), presented with unstable angina. Cardiac catheterization showed left main and triple-vessel disease. The saphenous vein graft (SVG) to the right coronary artery was diseased but patent, and the SVG to the left anterior descending artery (LAD) was occluded. Preoperative evaluation showed a heavily calcified ascending aorta and minimum disease on the descending aorta. He successfully underwent a left thoracotomy 2-vessel off-pump CABG using the descending aorta for the proximal anastomosis. The left thoracotomy approach is a useful alternative to avoid complications associated with resternotomy, especially in patients with a hostile chest, although visualization of the target vessels may be limited.