Left thoracotomy for reoperative revascularization of the posterior coronary circulation

Reoperative sternotomy for repeat coronary artery revascularization is known to have increased morbidity and mortality when compared to first time sternotomy. The increased risk involve damage to the heart itself, injury to previously placed bypass grafts, embolization of debris from manipulation of diseased grafts leading to possible myocardial infarction as well as the numerous other hazards which may complicate a difficult reoperative dissection. The use of the left thoracotomy for reoperative revascularization of the left thoracotomy for reoperative revascularization of the posterior coronary circulation avoids to the usual hazards of reoperative sternotomy. This approach allows for easy access to the posterior circulation not only for vein graft placement but also for the use of the mammary artery for grafting when necessary. Through the use of an illustrative case report and the discussion of previously reported cases the technique of the procedure as well as its variations and applications is described. The technique of left thoracotomy for reoperation revascularization in selected cases represents a useful alternative in the armamentarium of cardiac surgeon.