title: Coronary artery reoperation through the left thoracotomy with hypothermic circulatory arrest.
abstract: BACKGROUND
  The left thoracotomy approach to avoid injury of the patent old graft and the myocardium with mid sternal reentry at coronary artery reoperation.
  
  
  METHODS
  The left thoracotomy approach was used in 13 patients. There were 11 men and 2 women with a mean age of 63 years, ranging from 39 to 75 years. Three patients were having their third coronary bypass operation. In 11 patients, distal anastomoses were performed under circulatory arrest with moderate hypothermia. In the other 2 patients, distal anastomoses were performed on a beating heart. No aortic cross-clamp was applied in all patients. The mean number of distal anastomoses was 1.8; the grafted vessels were 11 anterior descending, 3 diagonal, 8 circumflex, and 1 posterolateral coronary arteries. Used grafts were 17 saphenous veins, 4 left internal thoracic arteries, and 2 gastroepiploic arteries. Inflow sites of the free graft were descending aorta in 10 patients and left subclavian artery in 3 patients.
  
  
  RESULTS
  All patients were alive and well at the mean follow-up of 16 months, and all grafts were patent.
  
  
  CONCLUSIONS
  The left thoracotomy approach is safe and effective for reoperation on the left coronary artery system, and circulatory arrest is convenient and safe for performing distal anastomosis.
authors.affiliation: Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Suma
authors.forename: I
authors.initials: I
authors.lastname: Kigawa
authors.forename: T
authors.initials: T
authors.lastname: Horii
authors.forename: J
authors.initials: J
authors.lastname: Tanaka
authors.forename: S
authors.initials: S
authors.lastname: Fukuda
authors.forename: Y
authors.initials: Y
authors.lastname: Wanibuchi
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013908:Thoracotomy; D016896:Treatment Outcome