Left thoracotomy approach in reoperative off-pump coronary revascularization |
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Authors: | Masahito Minakawa Kenji Takahashi Norihiro Kondo Masaharu Hatakeyama Toshihiko Kuga and Ikuo Fukuda |
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Institution: | (1) Department of Cardiovascular Surgery, Aomori Rosai Hospital, I Minamigaoka, Shirogane, Hachinohe, 031-0822 Aomori, Japan;(2) Department of Surgery I, Hirosaki University School of Medicine, Aomori, Japan |
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Abstract: | Objective: Reoperative coronary bypass grafting is at high risk. Particularly in redo cases where the patent graft is running near
the midline of the sternum, the graft may be exposed to injury by a median sternotomy and subsequent dissection. Whereas,
off-pump bypass grafting from the left axillary artery or descending thoracic artery by a left thoracotomy approach is safe
for preventing graft damage.Methods: From March 1998 to February 2002, we performed off-pump coronary artery bypass grafting by a left thoracotomy approach in
9 patients. The left axillary artery was used as the inflow vessel in 4 cases, and the descending thoracic, aorta in 5.Results: The radial artery was anastomosed proximally to the axillary artery in 4 cases and the descending thoracic aorta in one
case. The saphenous vein graft was anastomosed, proximally to the descending thoracic aorta in 4 cases. Transdiaphragmatic
minimally invasive bypass grafting for the right coronary artery was simultaneously performed in 3 cases. Postoperative cardiac
events were ventricular arrhythmia in 6 cases and supraventricular arrhythmia in 3 cases. There was no damage to the patent
grafts. Postoperative coronary angiography performed, in 8 cases revealed all the grafts to be patent without stenosis. Cardiac
symptoms were not found after the operation in any of the cases.Conclusions: These procedures can prevent the injury to patent grafts caused by a median sternotomy, and will be one of the useful strategies
for reoperative off-pump coronary artery bypass grafting. |
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Keywords: | thoracotomy axillary artery descending thoracic aorta coronary artery bypass off-pump bypass |
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