Reoperative "off-pump" circumflex revascularization via left thoracotomy: How to prevent graft kinking

Reoperative circumflex revascularization can be performed through a left th oracotomy approach, with or without cardiopulmonary bypass. In such cases, establishing the appropriate length of coronary grafts connecting the desce nding thoracic aorta to one of the marginal branches of the circumflex coro nary artery may be problematic. In fact, if these grafts are too long they may kink, whereas if left too short they may be injured by respiratory excu rsions of the left lower lobe of the lung. In this report we describe a tec hnique that can prevent these potential complications. (Ann Thorac Surg 200 0;70:309-10) (C) 2000 by The Society of Thoracic Surgeons.