title: Extra-anatomic redo of MIDCAB and OPCAB: an early experience.
abstract: BACKGROUND
  Eighteen patients with unstable angina underwent repeat myocardial revascularization without cardiopulmonary bypass using saphenous vein grafts from either the left (13) or right (2) axillary arteries or the descending thoracic aorta (3). Patients' ages ranged from 53 to 85 years. Left ventricular ejection fractions ranged from 15% to 60%.
  
  
  METHODS
  In 14 patients, the heart was exposed through an anterior thoracotomy, a minimally invasive direct coronary artery bypass (MIDCAB) technique. In 3 patients a left posterolateral thoractomy (lateral MIDCAB) was performed. One patient underwent repeat sternotomy (off-pump coronary artery bypass: OPCAB). In MIDCAB and lateral MIDCAB patients, the "target" vessel was a coronary artery in 8 patients and a previously placed vein graft in the remaining 9 patients. One patient underwent repeat sternotomy, and 3 coronary arteries were bypassed with a complex vein graft attached to the left axillary artery. Two patients died of mesenteric ischemia on the 2nd and 7th postoperative day. The remainder of patients were discharged from the hospital free of angina. Early graft patency was demonstrated by noninvasive vascular laboratory testing and/or angiography in the 13 survivors in whom the axillary artery had been the site of the proximal anastomosis.
  
  
  RESULTS
  Follow-up ranged from 1 to 25 months. No other patients have died, and none have undergone additional surgical or catheter-based procedures. Three patients have developed recurrent angina, and in 4 patients the extra-anatomic bypass grafts have apparently become occluded.
  
  
  CONCLUSIONS
  Extra-anatomic, off-pump bypass from the axillary artery or descending thoracic aorta to one or more coronary arteries can be performed safely in seriously ill patients requiring a repeat bypass procedure. The early results, regarding relief of angina, are encouraging.
authors.affiliation: Department of Surgery, Lehigh Valley Hospital, Allentown, PA 18105-1556, USA. sally.lutz@lvh.com
authors.forename: M C
authors.initials: MC
authors.lastname: Sinclair
authors.forename: M
authors.initials: M
authors.lastname: LeBoutillier
authors.forename: W
authors.initials: W
authors.lastname: Gee
authors.forename: T
authors.initials: T
authors.lastname: Phillips
authors.forename: R L
authors.initials: RL
authors.lastname: Singer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000789:Angina, Unstable / Q000175:diagnosis / Q000601:surgery*; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000637:transplantation; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011379:Prognosis; D012086:Reoperation; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler