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Related Experiment Videos

Reoperative CABG using left thoracotomy: a tailored strategy.

J G Byrne1, L Aklog, D H Adams

  • 1Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. jgbyrne@bics.bwh.harvard.edu

The Annals of Thoracic Surgery
|February 24, 2001
PubMed
Summary

Reoperative coronary artery bypass grafting (CABG) via left thoracotomy is complex. A tailored strategy using multiple techniques, including off-pump CABG, offers a viable approach for challenging cases.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery

Background:

  • Reoperative coronary artery bypass grafting (CABG) through a left thoracotomy presents significant surgical challenges.
  • A dominant surgical approach for this procedure has not been established.

Purpose of the Study:

  • To present a tailored strategy for reoperative CABG via left thoracotomy.
  • To integrate newer technologies into surgical decision-making for these complex patients.

Main Methods:

  • A consecutive series of 50 patients undergoing reoperative CABG via left thoracotomy between 1991 and 1999.
  • Surgical approaches included conventional cardiopulmonary bypass (n=33), Heartport endoaortic balloon occlusion (n=4), and off-pump beating heart techniques (n=13).
  • Patient demographics and graft patency rates were recorded.

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Main Results:

  • The off-pump CABG technique was increasingly utilized in later cases.
  • Operative mortality was 6% (3 of 50 patients), with deaths occurring in the conventional and endoaortic occlusion groups.
  • The mean length of hospital stay for survivors was 7.8 days.

Conclusions:

  • Reoperative CABG via left thoracotomy remains a challenging procedure.
  • A combination of surgical techniques, including off-pump CABG, conventional cardiopulmonary bypass, circulatory arrest, and endoaortic balloon occlusion, should be available.
  • A tailored approach based on patient indications is crucial for successful outcomes.