Limited Left Thoracotomy for Reoperative Coronary Artery Bypass Grafting without Cardiopulmonary Bypass for Circumflex Grafting in Patients with Patent Internal Thoracic Artery Graft

Authors

  • Sérgio Almeida de Oliveira
  • Luiz Augusto F. Lisboa
  • Luís Alberto O. Dallan
  • Luiz Boro Puig
  • Guilherme M. Succi
  • Carlos A. Abreu Filho

DOI:

https://doi.org/10.1532/hsf.1139

Abstract

Background: We describe our experience with the limited left thoracotomy strategy for reoperative coronary artery bypass graft (CABG) to the circumflex coronary artery system, emphasizing the indications, our particular operative technique, and early clinical follow-up.

Methods: From January 2001 to January 2002, 8 consecutive patients underwent redo revascularization via limited left thoracotomy and without cardiopulmonary bypass. This operation was indicated for patients with recurrent myocardial ischemia confined to the lateral wall of the left ventricle, especially if a patent left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) graft was present.

Results: All 8 patients underwent successful redo revascularization via limited left thoracotomy. Eight patients received 14 saphenous vein grafts (mean 1.7 grafts/patient). No instances of postoperative myocardial infarction or death occurred. During a follow-up period ranging from 1 to 12 months (mean, 5.2 months), all patients were asymptomatic and without evidence of ischemia or infarction.

Conclusions: For select patients who have patent LITA grafted into the LAD and who need redo CABG to the coronary artery circumflex system, the limited left thoracotomy approach without cardiopulmonary bypass is a safe operation and a less invasive alternative to repeat sternotomy and conventional CABG.

References

Akins CW, Buckley MJ, Dagget WM, et al. 1994. Reoperative coronary grafting: changing patient profiles, operative indications, techniques, and results. Ann Thorac Surg 58:359-65.nBaumgartner FJ, Gheissari A, Panagiotides GP, Capouya ER, Declusin RJ, Yokoyama T. 1999. Off-pump obtuse marginal grafting with local stabilization: thoracotomy approach in reoperations. Ann Thorac Surg 68:946-8.nBurlingame MW, Bonchek LI, Vazales BE. 1988. Left thoracotomy for reoperative coronary bypass. J Thorac Cardiovasc Surg 95:508-10.nCalafiore AM, Giammarco G, Teodori G, et al. 1996. Left anterior descending coronary artery grafting via left anterior small thoracotomywithout cardiopulmonary bypass. Ann Thorac Surg 61:1658-63; Discussion 1664-5.nCampeau L, Enjalbert M, Lespérance J, Vaislic C, Grondin CM, Bourassa MG. 1983. Atherosclerosis and late closure of aortocoronary saphenous vein grafts: sequential angiographic studies at 2 weeks, 1 year, 5 to 7 years, and 10 to 12 years after surgery. Circulation 68:1-7.nCheung D, Flemma RJ, Mullen DC, Lepley D. 1982. An alternative approach to isolated circumflex coronary bypass reoperations. Ann Thorac Surg 33:302-3.nDewey TM, Magee M, Edgerton J, et al. 2001. Left mini-thoracotomy for beating heart bypass grafting: a safe alternative to high-risk intervention for select grafting of the circumflex artery distribution. Circulation 104(Suppl I)I-99-101.nDobell AR, Jain AK. 1984. Catastrophic hemorrhage during redo sternotomy. Ann Thorac Surg 37:273-8.nKeon WJ, Heggtveit HA, Leduc J. 1982. Perioperative myocardial infarction caused by atheroembolism. J Thorac Cardiovasc Surg 84:849-5.nLajos TZ, Akhter M, Bergsland J, et al. 2000. Limited access left thoracotomy for reoperative coronary artery disease: on or off pump. J Card Surg 15:291-5.nLytle BW, Loop FD, Cosgrove DM, et al. 1987. Fifteen hundred coronary reoperations. Results and determinants of early and late survival. J Thorac Cardiovasc Surg 93:847-59.nMiyaji K, Wolf RK, Flege JB Jr. 1999. Minimally invasive direct coronary artery bypass for redo patients. Ann Thorac Surg 67:1677-81.nMotwani JG, Topol EJ. 1998. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition and prevention. Circulation 97:916-31.nOliveira SA, Lisboa LAF, Dallan LAO, Rojas SO, Poli de Figueiredo LF. 2002. Minimally invasive single-vessel coronary artery bypass with the internal thoracic artery and early postoperative angiography: midterm results of a prospective study in 120 consecutive patients. Ann Thorac Surg 73:505-10.nPuig LB, Neto LF, Rati M, et al. 1984. A technique of anastomosis of the right internal mammary artery to the circumflex artery and its branches. Ann Thorac Surg 38:533-4.nDoty JR, Salazar JD, Fonger JD, Walinsky PL, Sussman MS, Salomon NW. 1998. Reoperative MIDCAB grafting: 3-year clinical experience. Eur J Cardiothorac Surg 13:641-9.nFaro RS, Javid H, Najafi H, Serry C. 1982. Left thoracotomy for reoperation for coronary revascularization. J Thorac Cardiovasc Surg 84:453-5.nFitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. 1996. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 28:616-26.nFonger JD, Doty JR, Sussman MS, Salomon NW. 1997. Lateral MIDCAB grafting via limited posterior thoracotomy. Eur J Cardiothorac Surg 12:399-404; Discussion 404-5.nGandjbakhch I, Acar C, Cabrol C. 1989. Left thoracotomy approach for coronary artery bypass grafting in patients with pericardial adhesions. Ann Thorac Surg 48:871-3.nGrosner G, Lajos TZ, Schimert G, Bergsland J. 1990. Left thoracotomy reoperation for coronary artery disease. J Cardiac Surg 5:304-8.nSubramanian VA, McCabe J, Geller CM. 1997. Minimally invasive direct coronary artery bypass grafting: two-year clinical experience. Ann Thorac Surg 64:1648-55.nSuma H, Kigawa I, Horii T, Tanaka JI, Fukuda S, Wanibuchi Y. 1995. Coronary artery reoperation through the left thoracotomy with hypothermic circulatory arrest. Ann Thorac Surg 60:1063-6.nUngerleider RM, Mills NL, Wechsler AS. 1985. Left thoracotomy for reoperative coronary artery bypass procedures. Ann Thorac Surg 40:11-5.nWalker WS, Sang CTM. 1986. Avoidance of patent anterior grafts at revisional coronary artery surgery: use of a lateral thoracotomy approach. Thorax 41:692-5.n

Published

2005-01-04

How to Cite

Oliveira, S. A. de, Lisboa, L. A. F., Dallan, L. A. O., Puig, L. B., Succi, G. M., & Filho, C. A. A. (2005). Limited Left Thoracotomy for Reoperative Coronary Artery Bypass Grafting without Cardiopulmonary Bypass for Circumflex Grafting in Patients with Patent Internal Thoracic Artery Graft. The Heart Surgery Forum, 7(1), E22-E26. https://doi.org/10.1532/hsf.1139

Issue

Section

Article