Off-pump obtuse marginal grafting with local stabilization: Thoracotomy approach in reoperations

Background. Redo coronary surgery in patients with patent internal mammary artery (IMA) grafts may be hazardous. A thoracotomy approach has been used to graft the circumflex branches to avoid injury from sternal re-entry. Com bining this approach with off-pump revascularization techniques may be usef ul. Methods. Seven consecutive patients who had undergone prior coronary revasc ularization developed symptoms attributable to lateral wall ischemia. Five of them had patent IMA grafts. These patients underwent off-pump obtuse mar ginal grafting using local immobilization techniques via a thoracotomy appr oach. Inflow was from the descending aorta in 6 patients and splenic artery in 1. Results. Obtuse marginal grafting was successfully performed in all cases w ithout need for cardiopulmonary bypass. Conclusions. Off-pump obtuse marginal grafting via the thoracotomy route ma p be useful in redo coronary surgery, particularly in instances of patent I MA grafts. (Ann Thorac Surg 1999;68:9-16-8) (C) 1999 by The Society of Thor acic Surgeons.