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[Left thoracotomy approach for coronary reoperation]
1Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
[Zasshi] [Journal]. Nihon Kyobu Geka Gakkai
|August 1, 1995
Summary
Left thoracotomy offers a viable surgical approach for reoperative coronary artery bypass grafting. This minimally invasive technique in selected patients reduces risks associated with sternal reentry, showing promising graft patency and no hospital mortality.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Reoperative coronary artery bypass grafting (CABG) is complex.
- Minimally invasive approaches are sought to reduce risks of sternal reentry.
Purpose of the Study:
- To evaluate the safety and efficacy of left thoracotomy for reoperative coronary revascularization.
- To assess graft patency and patient outcomes.
Main Methods:
- Retrospective review of 12 patients undergoing reoperative CABG via left thoracotomy (June 1992-June 1994).
- Grafting primarily to the left coronary system, with one patient receiving additional bypass to the right coronary artery.
- Surgical techniques included pedicled left internal thoracic artery, free gastroepiploic artery, reversed saphenous vein grafts, and off-pump procedures in one case.
Main Results:
- All 12 patients were hemodynamically stable postoperatively with a mean ventilation time of 15.7 hours.
- No hospital deaths occurred; morbidity included reexploration for hemorrhage, convulsion, hemianopsia worsening, ventricular arrhythmia, and wound complications.
- Repeat coronary angiography showed widely patent grafts in all but one patient.
Conclusions:
- Left thoracotomy is a useful approach for reoperative coronary bypass in selected patients.
- This technique may reduce surgical risks compared to sternal reentry.
- The study demonstrates feasibility and acceptable outcomes for this minimally invasive strategy.