title: Off-pump obtuse marginal grafting with local stabilization: thoracotomy approach in reoperations.
abstract: BACKGROUND
  Redo coronary surgery in patients with patent internal mammary artery (IMA) grafts may be hazardous. A thoracotomy approach has been used to graft the circumflex branches to avoid injury from sternal re-entry. Combining this approach with off-pump revascularization techniques may be useful.
  
  
  METHODS
  Seven consecutive patients who had undergone prior coronary revascularization developed symptoms attributable to lateral wall ischemia. Five of them had patent IMA grafts. These patients underwent off-pump obtuse marginal grafting using local immobilization techniques via a thoracotomy approach. Inflow was from the descending aorta in 6 patients and splenic artery in 1.
  
  
  RESULTS
  Obtuse marginal grafting was successfully performed in all cases without need for cardiopulmonary bypass.
  
  
  CONCLUSIONS
  Off-pump obtuse marginal grafting via the thoracotomy route may be useful in redo coronary surgery, particularly in instances of patent IMA grafts.
authors.affiliation: St. Vincent Medical Center, Los Angeles, USA.
authors.forename: F J
authors.initials: FJ
authors.lastname: Baumgartner
authors.forename: A
authors.initials: A
authors.lastname: Gheissari
authors.forename: G P
authors.initials: GP
authors.lastname: Panagiotides
authors.forename: E R
authors.initials: ER
authors.lastname: Capouya
authors.forename: R J
authors.initials: RJ
authors.lastname: Declusin
authors.forename: T
authors.initials: T
authors.lastname: Yokoyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009204:Myocardial Revascularization / Q000379:methods*; D012086:Reoperation; D013525:Surgical Instruments; D013908:Thoracotomy / Q000295:instrumentation / Q000379:methods*; D014654:Vascular Patency