AI Article Synopsis
- Reoperative CABG can be technically challenging, especially for patients who cannot undergo sternotomy or CPB, but this study examined a method using a thoracotomy technique without CPB.
- From 1996 to 1999, 21 patients were treated with this approach, and none required sternotomy or CPB, resulting in no hospital deaths and low rates of postoperative complications.
- Findings show a 95% survival rate at 2 years, with most patients experiencing significant improvement in heart function, suggesting this technique is effective for reoperating on the circumflex artery system.
Article Abstract
Background: Reoperative coronary artery bypass grafting (CABG) in patients with contraindications to sternotomy or cardiopulmonary bypass (CPB) presents a technical challenge. In this study we reviewed patient selection, operative technique, and early results in patients having redo-CABG to the circumflex artery system by a thoracotomy without CPB.
Methods: From January 1996 through December 1999, 21 patients with contraindications to conventional redo-CABG had target vessel revascularization off-pump by thoracotomy. A posterolateral thoracotomy approach was used.
Results: No patient required sternotomy or CPB. There was no hospital mortality. Postoperative cardiac morbidity included non-Q wave myocardial infarction (5%), need for intraaortic balloon pump support postoperatively (5%), and atrial fibrillation (5%). Two grafts were studied early and two were studied late (more than 6 months later). One venous graft was found to be occluded early. Survival at 2 years was 95%. Ninety percent of surviving patients were in New York Heart Association functional class I or II.
Conclusions: This approach was associated with no mortality, low morbidity, and favorable early symptomatic improvement. This is the approach of choice in cases of reoperative CABG to the circumflex system when resternotomy or CPB are undesirable, and the culprit coronary vessels are accessible through a thoracotomy.
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| http://dx.doi.org/10.1016/s0003-4975(01)02617-0 | DOI Listing |
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