Repeated coronary artery bypass grafting combined with indirect myocardial revascularization - YurLeon procedure on a working heart from a left-sided minithoracotomy

Despite the development of medical and surgical treatment of patients with coronary artery disease, standard methods are not applicable in determining the tactics of managing a number of patients. A unique clinical case of a 56-year-old female patient who, 15 years before hospitalization, underwent coronary artery bypass grafting of atherosclerotic coronary arteries from the sternotomy approach is presented. After 10 years from the operation, she began to worry about relapses of angina pectoris. Control examination revealed occlusion of the shunt to the anterior interventricular artery, which caused ischemia of the anterior and lateral walls of the left ventricle according to the results of scintigraphy. In order to minimize the operative access and in connection with the high risk of performing sternotomy, as well as due to the diffuse nature of the coronary bed lesion, a minimally invasive surgical approach from the left-sided thoracotomy was chosen, while, along with the diagonal branch bypass, the technique of stimulating extracardiac angiogenesis (YurLeon) was performed. The postoperative period and follow-up for 1 year - with significant positive dynamics. Gentle access, along with the use of the YurLeon technique, made it possible to achieve a good result in a patient with diffuse atherosclerosis preceding CABG, moreover, reducing the degree of surgical aggression.