Related Experiment Video
Updated: Aug 17, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Off-pump reoperative coronary artery bypass grafting by thoracotomy: patient selection and operative technique
F M Azoury1, A M Gillinov, B W Lytle
1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
Insights
Reoperative coronary artery bypass grafting (CABG) using thoracotomy without cardiopulmonary bypass (CPB) offers a safe alternative for patients with sternotomy contraindications. This off-pump approach achieved no mortality and good long-term functional outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Reoperative coronary artery bypass grafting (CABG) poses challenges for patients unsuitable for sternotomy or cardiopulmonary bypass (CPB).
- Conventional redo-CABG techniques may carry significant risks for select patient populations.
Purpose of the Study:
- To evaluate the safety and efficacy of off-pump redo-CABG via thoracotomy for circumflex artery revascularization.
- To assess patient selection, surgical technique, and early outcomes in this specific patient group.
Main Methods:
- A posterolateral thoracotomy approach was utilized for off-pump redo-CABG in 21 patients.
- Patients had contraindications to conventional sternotomy and CPB during the study period (1996-1999).
Main Results:
- No patient required sternotomy or CPB, and there was no hospital mortality.
- Low postoperative morbidity included myocardial infarction (5%), need for intra-aortic balloon pump (5%), and atrial fibrillation (5%).
- Two-year survival was 95%, with 90% of survivors in New York Heart Association functional class I or II.
Conclusions:
- Off-pump redo-CABG via thoracotomy is a viable approach with no mortality and low morbidity.
- This technique is recommended for reoperative CABG to the circumflex system when sternotomy or CPB are contraindicated or undesirable.
Background:
Reoperative coronary artery bypass grafting (CABG) in patients with contraindications to sternotomy or cardiopulmonary bypass (CPB) presents a technical challenge. In this study we reviewed patient selection, operative technique, and early results in patients having redo-CABG to the circumflex artery system by a thoracotomy without CPB.
Methods:
From January 1996 through December 1999, 21 patients with contraindications to conventional redo-CABG had target vessel revascularization off-pump by thoracotomy. A posterolateral thoracotomy approach was used.
Results:
No patient required sternotomy or CPB. There was no hospital mortality. Postoperative cardiac morbidity included non-Q wave myocardial infarction (5%), need for intraaortic balloon pump support postoperatively (5%), and atrial fibrillation (5%). Two grafts were studied early and two were studied late (more than 6 months later). One venous graft was found to be occluded early. Survival at 2 years was 95%. Ninety percent of surviving patients were in New York Heart Association functional class I or II.
Conclusions:
This approach was associated with no mortality, low morbidity, and favorable early symptomatic improvement. This is the approach of choice in cases of reoperative CABG to the circumflex system when resternotomy or CPB are undesirable, and the culprit coronary vessels are accessible through a thoracotomy.
More Related Videos
08:50Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
05:25Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023