Off-pump reoperative coronary artery bypass grafting by thoracotomy: Patient selection and operative technique

Background. Reoperative coronary artery bypass grafting (CABG) in patients with contraindications to sternotomy or cardiopulmonary bypass (CPB) presen ts a technical challenge. In this study we reviewed patient selection, oper ative technique, and early results in patients having redo-CABG to the circ umflex artery system by a thoracotomy without CPB. Methods. From January 1996 through December 1999, 21 patients with contrain dications to conventional redo-CABG had target vessel revascularization off -pump by thoracotomy. A posterolateral thoracotomy approach was used. Results. No patient required sternotomy or CPB. There was no hospital morta lity. Postoperative cardiac morbidity included non-Q wave myocardial infarc tion (5%), need for intraaortic balloon pump support postoperatively (5%), and atrial fibrillation (5%). Two grafts were studied early and two were st udied late (more than 6 months later). One venous graft was found to be occ luded early. Survival at 2 years was 95%. Ninety percent of surviving patie nts were in New York Heart Association functional class I or II. Conclusions. This approach was associated with no mortality, low morbidity, and favorable early symptomatic improvement. This is the approach of choic e in cases of reoperative CABG to the circumflex system when resternotomy o r CPB are undesirable, and the culprit coronary vessels are accessible thro ugh a thoracotomy. (C) 2001 by The Society of Thoracic Surgeons.