title: Left thoracotomy approach in reoperative off-pump coronary revascularization: bypass grafting from the left axillary artery or descending thoracic aorta.
abstract: OBJECTIVE
  Reoperative coronary bypass grafting is at high risk. Particularly in redo cases where the patent graft is running near the midline of the sternum, the graft may be exposed to injury by a median sternotomy and subsequent dissection. Whereas, off-pump bypass grafting from the left axillary artery or descending thoracic artery by a left thoracotomy approach is safe for preventing graft damage.
  
  
  METHODS
  From March 1998 to February 2002, we performed off-pump coronary artery bypass grafting by a left thoracotomy approach in 9 patients. The left axillary artery was used as the inflow vessel in 4 cases, and the descending thoracic aorta in 5.
  
  
  RESULTS
  The radial artery was anastomosed proximally to the axillary artery in 4 cases and the descending thoracic aorta in one case. The saphenous vein graft was anastomosed proximally to the descending thoracic aorta in 4 cases. Transdiaphragmatic minimally invasive bypass grafting for the right coronary artery was simultaneously performed in 3 cases. Postoperative cardiac events were ventricular arrhythmia in 6 cases and supraventricular arrhythmia in 3 cases. There was no damage to the patent grafts. Postoperative coronary angiography performed in 8 cases revealed all the grafts to be patent without stenosis. Cardiac symptoms were not found after the operation in any of the cases.
  
  
  CONCLUSIONS
  These procedures can prevent the injury to patent grafts caused by a median sternotomy, and will be one of the useful strategies for reoperative off-pump coronary artery bypass grafting.
authors.affiliation: Department of Cardiovascular Surgery, Aomori Rosai Hospital, Hachinohe, Aomori, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Minakawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Takahashi
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kondo
authors.forename: Masaharu
authors.initials: M
authors.lastname: Hatakeyama
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kuga
authors.forename: Ikuo
authors.initials: I
authors.lastname: Fukuda
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome