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The left thoracotomy approach is an alternative technique for coronary revascularization to avoid complications associated with re-sternotomy, such as injury to patent grafts, right ventricle, aorta, during re-sternotomy. Situations such as calcification of the ascending aorta and previous mediastinitis favor the use of the left thoracotomy approach. Revascularization of the circumflex territory via a lateral thoracotomy has been reported previously. However, reports of revascularization of the LAD combined with circumflex artery territory via left thoracotomy approach are rare. We successfully performed an off-pump CABG by left thoracotomy in a complex redo case to revascularize the LAD and obtuse marginal branch (OM) in an 83 year-old-man who had CABG and AVR in the past with a heavily calcified ascending aorta.

Case Report:

83-year-old caucasian male

History of CABG 20 years ago, redo CABG in the following year due to graft failure, and an AVR with a mechanical valve 12 years ago, and multiple coronary interventions.

Presented with unstable angina.

Echo showed normal LV function

Due to his history of early stent re-stenosis and location of the disease, he was considered not suitable for repeat PCI.

CT Scan showed severe calcification of the ascending aorta (left), and mild disease on the descending aorta.

Presented at Chest 2013. Chicago IL.October 26-31, 2013.

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