Bilateral Minithoracotomy Approach for Off-Pump Coronary Artery Bypass Grafting in a Patient With Retrosternal Gastric Tube Reconstruction.

Retrosternal gastric tube reconstruction after esophagectomy can make coronary artery bypass grafting technically challenging because the gastric tube often occupies the retrosternal space and may lie close to major mediastinal structures. We report a case of multivessel coronary artery disease in a patient with previous esophagectomy and retrosternal gastric tube reconstruction. To avoid gastric tube injury and enable safe multivessel revascularization, off-pump coronary artery bypass grafting was performed through bilateral minithoracotomies, with proximal anastomosis through a right minithoracotomy and distal anastomoses through a left minithoracotomy.