Thoracoscopic mammary artery mobilization in redo minimally invasive coronary bypass operations

Background. It has been stated that thoracoscopic internal thoracic artery (ITA) mobilization is not recommended in the redo minimally invasive direct coronary artery bypass (FI MIDCAB) situation, presumably because adhesions from the previous coronary artery bypass grafting operation may preclude a thoracoscopic approach. However, there are advantages to thoracoscopic ITA mobilization in MIDCAB that could also be realized in the redo situation. Methods. In 200 MIDCAB procedures over the last 3 and a half years, 11 pati ents, ages 49-83 (mean 69), were identified as having undergone an attempte d ITA mobilization in a redo situation. Results. Thoracoscopic ITA mobilization was successful in 9 out of 11 patie nts (81%). One patient had complete pleural symphysis precluding this appro ach, and 1 patient had poor mammary now after harvest and this conduit was not used. Both failures were in female octogenarians. Conclusions. To realize the advantages of a tharacoscopic ITA mobilization MIDCAB, both right and left thoracoscopic ITA mobiIization can safely be pe rformed in the redo situation. Thoracic adhesions precluding a thoracoscopi c approach were encountered in only 1 of 11 redo coronary artery bypass gra fting patients. (C) 1999 by The Society of Thoracic Surgeons.