Redo off-pump coronary artery bypass grafting via a left thoracotomy
1Department of Cardiac Surgery, Guven Hospital, Ankara, Turkey. ibrahimduvan@hotmail.com.
Insights
Redo off-pump coronary artery bypass graft (CABG) surgery using a left posterolateral thoracotomy is a safe and effective option for revascularizing the circumflex artery. This approach demonstrated lower postoperative morbidity and mortality in selected patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Retrospective review of redo off-pump coronary artery bypass graft (CABG) in a selected patient cohort.
- Focus on revascularization of the circumflex artery (Cx) and its branches from the descending aorta.
Purpose of the Study:
- To evaluate the safety and efficacy of redo off-pump CABG via left posterolateral thoracotomy.
- To assess postoperative morbidity and mortality rates in patients requiring revascularization of the Cx and its branches.
Main Methods:
- Retrospective analysis of 32 patients undergoing redo off-pump CABG between 2001 and 2013.
- Procedure performed via left posterolateral thoracotomy, targeting the descending aorta to Cx and branches.
- Graft conduits included saphenous vein or radial artery; all patients had a patent left internal thoracic artery-to-left anterior descending coronary artery (LITA-LAD) anastomosis.
Main Results:
- Primary indications for surgery included new lesion formation (19 patients), graft occlusion (6 patients), or both (7 patients).
- Average operating time was 143.90 minutes; respiratory assist, ICU, and hospital stays were 5.08 hours, 21.3 hours, and 5.06 days, respectively.
- Over a mean follow-up of 56.17 months, 22 patients were alive and free of cardiac problems; 4 patients died.
Conclusions:
- Redo off-pump CABG via left posterolateral thoracotomy is a safe and effective surgical strategy.
- This approach offers lower postoperative morbidity and mortality for Cx revascularization.
- The technique is suitable for patients requiring repeat bypass grafting to the circumflex system.
Background:
In this study, we retrospectively reviewed our experience in a meticulously selected group of patients undergoing redo off-pump coronary artery bypass graft (CABG) surgery from the descending aorta to the circumflex artery (Cx) and its branches.
Methods:
Between January 2001 and October 2013, 32 patients at our hospital underwent redo off-pump CABG from the descending aorta to the Cx and its branches via a left posterolateral thoracotomy. Of these patients, 27 were male (84.3%) and five were female (15.7%), with a mean age of 61.66 ± 8.63 years. All patients had a patent left internal thoracic artery-to-left anterior descending coronary artery (LITA-LAD) anastomosis. Thoracotomy was performed through the fifth intercostal space. The saphenous vein or radial artery was prepared as a graft at the same time as the left posterolateral thoracotomy from the contralateral extremity, without any positional problem.
Results:
The main reasons for surgery in this group of patients were new lesion formation in 19, graft occlusion in six, and both in seven patients. The average operating time was 143.90 ± 36.93 minutes, respiratory assist time was 5.08 ± 1.88 hours, intensive care unit (ICU) stay was 21.3 ± 4.41 hours and hospital stay was 5.06 ± 2.74 days. Thirty-eight bypasses were performed. The follow-up period was 56.17 ± 39.2 months. Six patients were lost in the follow-up period and four patients died. Twenty-two were alive and free of cardiac problems.
Conclusion:
Redo off-pump CABG via a left posterolateral thoracotomy provided a safe and effective surgical approach with lower rates of postoperative morbidity and mortality in patients who required revascularisation of the Cx and its branches.
