title: Left mini-thoracotomy for beating heart bypass grafting: a safe alternative to high-risk intervention for selected grafting of the circumflex artery distribution.
abstract: BACKGROUND
  Progression of disease and bypass graft attrition results in a population of patients who require repeated coronary interventions. Frequently, these patients have patent internal mammary artery grafts and require isolated intervention to the circumflex distribution. As an alternative to high-risk repeated sternotomy and conventional bypass surgery or catheter-based intervention, the circumflex marginal vessels may be approached by thoracotomy. We reviewed our experience in revascularizing the circumflex distribution with off-pump techniques via left mini-thoracotomy.
  
  
  RESULTS
  Thirty-two patients underwent off-pump bypass grafting of the circumflex vessels via thoracotomy from December 1995 to April 2000. Twenty-seven patients presented with circumflex disease after having previous bypass grafting. Five patients, who presented with circumflex disease and either nondiseased or ungraftable disease in their other arteries, were revascularized as a primary procedure. There was no observed mortality. Seven patients (22%) required inotropes on leaving the operating room, and 3 patients (9.4%) received transfusion of packed red blood cells. There was 1 reoperation for bleeding and 1 patient with a postoperative neurological deficit. There were no perioperative myocardial infarctions. The average length of stay was 4.8 days from time of surgery to discharge.
  
  
  CONCLUSIONS
  Off-pump grafting via thoracotomy provides a safe and effective alternative approach for patients requiring limited revascularization. Potential cardiac injury and danger to viable grafts from repeated sternotomy is minimized, and manipulation of the diseased ascending aorta is avoided. Morbidity, hospital length of stay, and cost are less than for conventional repeated coronary bypass surgery.
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA. Tdewey@CSANT.com
authors.forename: T M
authors.initials: TM
authors.lastname: Dewey
authors.forename: M
authors.initials: M
authors.lastname: Magee
authors.forename: J
authors.initials: J
authors.lastname: Edgerton
authors.forename: R
authors.initials: R
authors.lastname: Vela
authors.forename: S L
authors.initials: SL
authors.lastname: Prince
authors.forename: T
authors.initials: T
authors.lastname: Acuff
authors.forename: M J
authors.initials: MJ
authors.lastname: Mack
mesh_terms: D001158:Arteries / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003326:Coronary Circulation; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007432:Intraoperative Period / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D020196:Trauma, Nervous System / Q000209:etiology; D016896:Treatment Outcome