Off Pump coronary artery revascularization via left thoracotomy —Early results

Background There are very few studies in literature, which have reported primary revascularization of the coronaries via a thoracotomy incision. We hereby present our initial experiences using this approach to off pump coronary revascularization. Patients and Methods 27 patients with coronary artery disease were selected for surgical revascularization via the thoracotomy approach. The left chest is entered through the 5^th intercostal space, and the left internal mammary artery (LIMA) pedicle is harvested under direct vision. The radial artery or saphenous vein is harvested simultaneously depending on the availability and suitability of the conduits. Using standard off pump techniques, the LIMA is anastomosed to the Left Anterior Descending Artery (LAD) followed by other distal anastomoses. Results Complete revascularization was achieved in all patients. The average number of grafts were 2.40. The mean blood loss during the first 6 hours was 380 ± 169 ml. None of the patients needed emergency conversion to cardiopulmonary bypass / sternotomy. Post operatively 4 patients had on table extubation. 1 patient was re-explored due to bleeding from the thoracotomy. There was no peri-operative Myocardial infarction and the mortality was nil. The average hospital stay was 6.4 ± 1 days. Conclusion Based on our initial experience, this approach appears to be safe and practical in selected cases. It is well tolerated hemodynamically, with minimal postoperative morbidity.