Limited access left thoracotomy for reoperative coronary artery disease: On or off pump

Between 1971 and 1988 left thoracotomy was performed on pump for selected r eoperations. Since 1993, 92 patients were operated on with a limited approa ch and an increased number of cases were done off pump (70 patients). The p urpose of this paper is to describe the transition of our operative techniq ues from on pump to off pump for reoperative coronary patients. From 1995 t o 1999, 22 patients (Group 1) were operated on pump and 70 patients (Group II) off pump; 86 of 92 (93.5%) had reoperations. The demographic data were similar in these two groups regarding age, gender, ejection fraction, and t otal number of grafts performed. In this study 92 patients had a crude mort ality of 4.3%. Limited access thoractomy provides safer reoperation than pr eviously (1971-1988) with an improved on or off pump (4.5% vs. 4.3%) mortal ity, compared to the on pump mortality of 10% between 1971-1988. Off-pump o perations are performed with increasing frequency and with the same risk an d less postoperative complications.