Redo off-pump coronary artery bypass grafting via a left thoracotomy

• Published in: Cardiovascular Journal of Africa Vol. 26; no. 1; pp. 25 - 28
• Main Authors: Duvan, I, Ates, S, Onuk, B E, Sungar, U P, Kurtoglu, M, Karagoz, Y H
• Format: Journal Article
• Language: English
• Published: South Africa Clinics Cardive Publishing 01-01-2015
• Subjects: Adult; Aged; Cardiovascular Topics; Coronary Artery Bypass, Off-Pump - adverse effects; Coronary Artery Bypass, Off-Pump - methods; Coronary Artery Bypass, Off-Pump - mortality; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Female; Graft Occlusion, Vascular - diagnosis; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - mortality; Graft Occlusion, Vascular - surgery; Humans; Internal Mammary-Coronary Artery Anastomosis - adverse effects; Internal Mammary-Coronary Artery Anastomosis - mortality; Male; Middle Aged; Patient Selection; Radial Artery - transplantation; Recurrence; Reoperation; Retrospective Studies; Risk Factors; Saphenous Vein - transplantation; Thoracotomy - adverse effects; Thoracotomy - mortality; Time Factors; Treatment Outcome; Turkey; Turkey
• ISSN: 1995-1892; 1680-0745
• DOI: 10.5830/CVJA-2014-06

In this study, we retrospectively reviewed our experience in a meticulously selected group of patients undergoing redo off-pump coronary artery bypass graft (CABG) surgery from the descending aorta to the circumflex artery (Cx) and its branches.
Between January 2001 and October 2013, 32 patients at our hospital underwent redo off-pump CABG from the descending aorta to the Cx and its branches via a left posterolateral thoracotomy. Of these patients, 27 were male (84.3%) and five were female (15.7%), with a mean age of 61.66 ± 8.63 years. All patients had a patent left internal thoracic artery-to-left anterior descending coronary artery (LITA-LAD) anastomosis. Thoracotomy was performed through the fifth intercostal space. The saphenous vein or radial artery was prepared as a graft at the same time as the left posterolateral thoracotomy from the contralateral extremity, without any positional problem.
The main reasons for surgery in this group of patients were new lesion formation in 19, graft occlusion in six, and both in seven patients. The average operating time was 143.90 ± 36.93 minutes, respiratory assist time was 5.08 ± 1.88 hours, intensive care unit (ICU) stay was 21.3 ± 4.41 hours and hospital stay was 5.06 ± 2.74 days. Thirty-eight bypasses were performed. The follow-up period was 56.17 ± 39.2 months. Six patients were lost in the follow-up period and four patients died. Twenty-two were alive and free of cardiac problems.
Redo off-pump CABG via a left posterolateral thoracotomy provided a safe and effective surgical approach with lower rates of postoperative morbidity and mortality in patients who required revascularisation of the Cx and its branches.