Left thoracotomy for reoperation for coronary revascularization

Repeat Surgery for Coronary Artery Bypass Grafting: The Role of the Left Thoracotomy Approach

“…Patent LIMA grafts • Prior mitral valve replacement to prevent lifting of • the heart Prior mediastinitis/sternal wound infection • Calcified ascending aorta • Prior mediastinal irradiation or radical mastectomy • [Burlingame 1988]. The procedure is not new, having been mentioned as early as 1982 [Faro 1982]. Credit should be given to Dr. Benetti for his pioneering work on the MIDCAB procedure [Benetti 1981], because some of the earlier off-pump redo procedures were performed as a MIDCAB by those experienced with this technique [Calafiore 1996;Boonstra 1997].…”

Toracotomia esquerda para reoperação de revascularização miocárdica

“…Other indications would be as follows: calcified ascending aorta, sternum osteomyelitis or mediastinitis in the first operation, mediastinal irradiation, requirement of concomitant left lung surgery and previous mitral valve replacement, what makes risky to rotate the heart to approach the posterior arteries [3,4,6].…”

“…Also, it is observed in the review of the literature that the operative technique has varied a lot. The majority of the groups have been using some type of extracorporeal circulation with the femoro-femoral bypass being the most used [2][3][4][5][6][7][8][9][10]. Some groups have been using hypothermia and ventricular fibrillation to make the anastomoses [2,4].…”

“…Although the outcomes of reoperative coronary artery bypass grafting have been improved along the years [1], some clinical situations, such as the internal thoracic artery grafts, carry a higher risk during resternotomy. In 1982, Cheung et al; [2] and Faro et al [3] independently described the experience in performing left thoracotomy for circumflex coronary artery revascularization in patients who had undergone previous cardiac surgery. The use of left thoracotomy for myocardial revascularization, besides to have been proven as a simple technique, has been sporadically reported [4][5][6][7][8][9][10][11][12][13][14][15].…”

Off‐Pump Versus On‐Pump Reoperative CABG Via a Left Thoracotomy for Circumflex Coronary Artery Revascularization

“…Reoperative CABG via a left thoracotomy (RCLT) has become a useful approach for patients requiring isolated revascularization of the circumflex coronary artery territory, and who are at high risk for a conventional approach 3–13 . The number of patients in previous reports is small and the long‐term follow‐up data after these operations are scarce.…”