Right thoracotomy for reoperative right coronary artery bypass procedures.
The use of a right thoracotomy is a safe alternative approach for reentering the mediastinum for reoperative right coronary artery bypass grafting. This technique was used in 9 patients and allowed minimal dissection, reducing the risks of hemorrhage and injury to previously placed patent grafts. Cardiopulmonary bypass was used in 4 patients in whom myocardial protection was accomplished with systemic hypothermia. Right atrial cannulation provided adequate venous return, with arterial inflow established via the femoral artery (n = 2) or ascending aorta (n = 2). In 5 patients, revascularization was accomplished by temporary coronary artery occlusion without cardiopulmonary support. There were no deaths, and postoperative recovery was not delayed. Postoperative chest drainage (mean +/- standard deviation, 1,076 +/- 718 mL) was significantly less (p < 0.01) than redo median sternotomy (1,352 +/- 602 mL) in a similar population. Eight of 9 patients remain free of angina 29 +/- 24.8 months postoperatively.
Uppal
R
R
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710.
Wolfe
W G
WG
Lowe
J E
JE
Smith
P K
PK
D000368:Aged; D003251:Constriction, Pathologic / Q000601:surgery; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012501:Saphenous Vein / Q000601:surgery; D013908:Thoracotomy / Q000379:methods*