Combined Thoraco-abdominal Aortic Aneurysm Repair and Coronary Artery Bypass Grafting through a Left Thoracotomy

Approximately 40% of the patients with aortic aneurysm have coronary artery disease(CAD), which is an important factor contributing to early mortality associated with aneurysm surgery. Combined coronary artery bypass grafting (CABG)and aortic aneurysm repair of the ascending aorta to the aortic arch is often performed through a median sternotomy due to a good surgical exposure. However, treatment strategy of thoraco-abdominal aortic aneurysm(TAAA) combined with CAD is often controversial. We report a successful case of a 69-year-old man who underwent TAAA repair and CABG through a left thoracotomy. Left thoracotomy via the 5th intercostal space with para-rectal incision provides a good surgical exposure of the thoraco-abdominal aorta and the left anterior descending artery(LAD). LAD was revascularized with a saphenous vein graft which was anastomosed to the descending aorta, followed by TAAA repair. The postoperative course was uneventful and the patient was discharged on 13th postoperative day without any complications.