REOPERATIVE CORONARY-BYPASS GRAFTING WITHOUT CARDIOPULMONARY BYPASS THROUGH A SMALL THORACOTOMY

Background. The danger of coronary reoperations is mainly hidden in th e reopening of the sternum and in the manipulation of the heart and th e old grafts. Therefore, the minimally invasive direct coronary artery bypass procedure seems an ideal technique for coronary reoperations i f only the left anterior descending coronary artery needs to be revasc ularized and the left internal mammary artery has not been used previo usly. Method. From January 1995 until May 1996 we performed 81 minimal ly invasive direct coronary artery bypass procedures through a small a nterolateral thoracotomy in the fifth intercostal space, anastomosing the left internal mammary artery to the left anterior descending coron ary artery. Six of these 81 were reoperative minimally invasive direct coronary artery bypass procedures on patients who had previously unde rgone coronary grafting through a median sternotomy with a vein graft to the left anterior descending coronary artery. Results. Mean operati on time was 85.8 +/- 22.2 minutes. Mean length of the mammary pedicles was 13 +/- 2 cm. Mean coronary occlusion time was 9.2 +/- 3.2 minutes . Mean postoperative hospital stay was 5.7 +/- 1.2 days (range, 5 to 8 days). No mortality and no cardiac-related morbidity were recorded. C onclusions. These results suggest that the technique is safe and promi sing in selected cases of reoperative coronary operation.