1985 - LEFT THORACOTOMY FOR REOPERATIVE CORONARY-ARTERY BYPASS PROCEDURES - 1993 UPDATE

This paper describes our experience in performing saphenous vein bypas s grafts to the circumflex coronary artery system with a left thoracot omy in 9 patients. Illustrative case reports demonstrate the spectrum of patients for whom this approach has been useful. The advantage of t his technique is that it allows the surgeon to avoid the adhesions tha t make a redo sternotomy time-consuming and potentially dangerous when previously patent saphenous vein or internal mammary grafts are prese nt. It is particularly useful for patients requiring grafting to the c ircumflex coronary artery system, especially if the patient is in rela tively unstable condition and would benefit from rapid institution of cardiopulmonary bypass. The technique generally employs cannulation of the descending thoracic aorta for arterial inflow and of the main pul monary artery for venous return. Usually the proximal end of the graft is easily placed to the left subclavian artery. Coronary anastomosis is performed on the cold (15-degrees-C), fibrillating heart, and aorti c cross-clamping and cardioplegic arrest have not been necessary. Vent ing is possible through the left atrial appendage should any rise in f illing pressures occur. Saphenous vein or internal mammary artery may be used. All patients undergoing this technique have had expeditious d ischarge from the hospital and excellent relief of symptoms. The techn ique is an alternative to median sternotomy for properly selected pati ents.