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Eur J Cardiothorac Surg 2007;32:65-68. doi:10.1016/j.ejcts.2007.03.046
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Should axillary artery to coronary artery bypass be part of the cardiac surgeon's armamentarium?

Ahmad M. Tarakji*, Michael C. Sinclair

Lehigh Valley Hospital, Allentown, PA, United States

Received 15 September 2006; received in revised form 28 February 2007; accepted 27 March 2007.

* Corresponding author. Address: Lehigh Valley Hospital, Department of Surgery, Cedar Crest & I-78, P.O. Box 689, Allentown, PA 18105-1556, United States. Tel.: +1 610 402 1296; fax: +1 610 402 1667. (Email: sally.lutz{at}lvh.com).

Background: The axillary artery has been used as an alternate inflow source for revascularization of the lower extremities for four decades. Since 1997, there have been several reports of axillary artery to coronary artery bypass. Methods: All cases of axillary artery to coronary artery bypass at our institution from 1997 through 2003 were reviewed. PubMed was queried for publications on this subject and all pertinent reports were reviewed. Results: Thirty-eight patients underwent axillary artery to coronary artery bypass at our hospital. Most (34) of the operations were performed without cardiopulmonary bypass. Saphenous vein (37) or radial artery (1) grafts were placed to one or more coronary arteries from either the left (36) or right (2) axillary artery. Twenty patients underwent sternotomy, and 18 had either a left (16) or right (2) minimally invasive direct coronary artery bypass (MIDCAB) procedure performed. Most of the sternotomies were for primary myocardial revascularization and most of the MIDCABs were reoperations. There were three deaths—all from non-cardiac causes, one myocardial infarction, and one transient brachial plexus injury. Doppler ultrasound, angiographic, and clinical follow-up were limited, but graft patency has been demonstrated up to 9 years. Conclusion: Axillary artery to coronary artery bypass should be part of the armamentarium of surgeons who perform myocardial revascularization operations.

Key Words: Axillary artery to coronary artery bypass • Myocardial revascularization • Extra-anatomic coronary bypass grafting • Coronary bypass grafting • Anterior thoracotomy • Redo MIDCAB






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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.