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Coronary artery bypass grafting after sternal turnover procedure and a review of the literature
Author(s) -
Imamura Yuki,
Kowatari Ryosuke,
Minakawa Masahito,
Fukuda Ikuo
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15478
Subject(s) - medicine , sternum , retractor , internal thoracic artery , median sternotomy , revascularization , surgery , artery , bypass grafting , radiology , cardiology , myocardial infarction
We report a case of complete revascularization after a sternal turnover procedure through median sternotomy in a patient with multivessel coronary artery disease. The patient had unusual anatomical features, such as the anterior protrusion of the middle‐to‐distal sternum and absent bilateral internal thoracic arteries (ITAs). The single‐blade sternum retractor and the Omni‐Tract retractors are simple and reliable tools for lifting and widening the thoracic wall around the xiphoid process. The bilateral radial arteries and the great saphenous vein were used as bypass grafts. Computed tomography was used to visualize the sternum supplied by the superior epigastric arteries (SEAs); presurgical abdominal ultrasonography revealed the course and crossing point of the developed SEAs. Since ITAs were absent, we preserved the SEAs to prevent sternal ischemia. No sternal complications or graft occlusion were observed during follow‐up.