Off-pump redo coronary artery bypass grafting via left thoracotomy

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Minimally Invasive Surgery

Background:

• Redo coronary artery bypass grafting (CABG) is increasingly common.
• Surgical approach selection for redo CABG impacts patient outcomes.
• Off-pump CABG via left thoracotomy (LT) is an alternative to re-median sternotomy (RMS).

Purpose of the Study:

• To evaluate the efficacy and safety of off-pump CABG via LT in patients requiring redo coronary revascularization.
• To compare outcomes between LT and RMS approaches for redo CABG.

Main Methods:

• Retrospective analysis of 21 patients undergoing redo CABG over 23 years.
• Patients divided into re-median sternotomy (RMS, n=12) and left thoracotomy (LT, n=9) groups.
• Comparison of postoperative respiratory failure, hospital stay, and mortality between groups.

Main Results:

• The LT group experienced no hospital deaths or respiratory failure.
• The RMS group had a significantly longer hospital stay and prolonged respiratory failure in 5/12 patients.
• Four in-hospital deaths (19.0%) occurred exclusively in the RMS group.

Conclusions:

• Redo CABG via LT yields satisfactory surgical results with improved safety.
• The LT approach facilitates rapid target coronary artery exposure with minimal myocardial damage.
• LT may be a valuable option for increasing numbers of redo CABG cases, especially in emergency settings.