Coronary Artery Bypass via Resternotomy after Pectus Excavatum Repair

Abstract

Pectus excavatum is a chest wall deformity that commonly warrants pediatric surgical correction for cosmesis or respiratory impairment via sternotomy. The repair typically consists of sternal wedge osteotomy and subsequent placement of a Steinman pin across the sternum with fixation to the ribs bilaterally. Coronary artery bypass grafting (CABG) after surgical repair of the sternum with a metal implant poses an intriguing surgical challenge. Literature review reveals only one such previously described case. We present a case of coronary revascularization in an adult who previously underwent pectus excavatum repair with ligation of the internal mammary arteries. Our coronary revascularization was accessed through a resternotomy after surgical removal of the metal implant previously placed during the pectus excavatum repair. Autologous greater saphenous vein was used as a conduit for bypass. The patient did well postoperatively and was discharged on postoperative day 4. The pectus repair remained intact even after the median sternotomy was performed. This was confirmed at the 1-year follow-up for the patient. Resternotomy after pectus excavatum repair with a prosthetic implant poses a challenge to cardiothoracic surgeons. Many such repairs have been described in the pediatric population. As our society ages and coronary artery disease becomes more prevalent, this unique situation may be more commonly encountered. We present an approach to coronary artery bypass grafting via median resternotomy after pectus excavatum repair.

Coronary artery bypass grafting after sternal turnover procedure and a review of the literature

“…In our literature review, we only found a few reports of patients with a history of pectus excavatum repair who underwent cardiac surgery, as well as cases of patients with a history of cardiac surgery who underwent recardiac surgery and pectus excavatum repair in parallel (Table 1). [2][3][4][10][11][12][13][14] In the past decades, numerous surgical techniques have been developed for the correction of the pectus excavatum. Although the most well-known is the Ravitch procedure, studies on performing cardiac surgery after the Ravitch procedure are lacking.…”

Left thoracotomy for coronary artery bypass grafting after sternoturnover for pectus excavatum: a case report

“…Although there are some reports of the first sternotomy for cardiac surgery in a patient with pectus excavatum [1] and simultaneous cardiac surgery and repair of pectus excavatum [2], median sternotomy after sternoturnover has been rarely reported. Mohan et al [3] performed CABG through sternotomy after sternal elevation with metal implant and noted that some surgeons recommend avoiding sternotomy as a repeat approach to the mediastinum. Kanaoka et al [4] reported a case of median sternotomy for aortic surgery 13 years after sternoturnover, followed by flail chest and 15-day mechanical ventilation.…”