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[Left thoracotomy approach for coronary reoperation]

I Kigawa1, H Suma, J Tanaka

  • 1Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.

[Zasshi] [Journal]. Nihon Kyobu Geka Gakkai
|August 1, 1995
PubMed
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.

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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.

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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.