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

Abstract

The procedure is safe, especially in patients with intact LIMA-to-LAD grafts needing lateral and inferior wall revascularization. Multislice computed tomography scanning allows better preoperative planning, especially regarding the site of implantation of the proximal graft, allowing a less invasive incision. The off-pump technique preserves cardiac and pulmonary function. The in-hospital death rate (1.8%) compares very well with the EuroSCORE-predicted mortality (14.2%).

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

“…Therefore, it may increase the risk of insufficient myocardial protection during the redo ATAAD surgery, which usually comprises prolonged CPB and cardiac arrest times. Furthermore, with a less invasive incision compared to resternotomy, left and right thoracotomies could be safe approaches and provide substantial benefits by reducing CPB time and postoperative bleeding for patients undergoing redo CABG and valvular surgeries 25,26 . However, these approaches were usually not considered as a preferable choice for treating ATAAD due to the unsatisfactory exposure of the aortic arch and aortic root.…”

Does grafting of the left anterior descending artery with the in situ right internal thoracic artery have an impact on late outcomes in the context of bilateral internal thoracic artery usage?

“…On the other hand, rapid advances in percutaneous options for treating both aortic as well as mitral valvular pathologies will almost preclude the need for resternotomy in patients with well-functioning BITA grafts and late presentation of degenerative valvular disease. Moreover, alternative surgical approaches are always possible to undertake repeat surgical revascularization 24 or valvular intervention. 25,26 The perceived increased risk for SWI continues to be a major reason for BITA underutilization.…”

Avoiding sternotomy in repeat coronary artery bypass grafting: Feasibility, safety, and mid-term outcome of the transabdominal off-pump technique using the right gastroepiploic artery

“…Left thoracotomy has been described as a suitable and safe technique in patients who need grafting to the lateral wall of the left ventricle. 4,5 When the right coronary artery (RCA) or the right posterior descending artery (PDA) is the only vessel involved, a small laparotomy with or without a T-shaped incision of the lower third of the sternum has been shown to be a useful alternative. [6][7][8] Despite the first successful experiences, reports of redo CABG without sternotomy and without CPB remain limited.…”