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Off-pump obtuse marginal grafting with local stabilization: thoracotomy approach in reoperations
F J Baumgartner1, A Gheissari, G P Panagiotides
1St. Vincent Medical Center, Los Angeles, USA.
Background:
Redo coronary surgery in patients with patent internal mammary artery (IMA) grafts may be hazardous. A thoracotomy approach has been used to graft the circumflex branches to avoid injury from sternal re-entry. Combining this approach with off-pump revascularization techniques may be useful.
Methods:
Seven consecutive patients who had undergone prior coronary revascularization developed symptoms attributable to lateral wall ischemia. Five of them had patent IMA grafts. These patients underwent off-pump obtuse marginal grafting using local immobilization techniques via a thoracotomy approach. Inflow was from the descending aorta in 6 patients and splenic artery in 1.
Results:
Obtuse marginal grafting was successfully performed in all cases without need for cardiopulmonary bypass.
Conclusions:
Off-pump obtuse marginal grafting via the thoracotomy route may be useful in redo coronary surgery, particularly in instances of patent IMA grafts.