title: Avoiding sternotomy in repeat coronary artery bypass grafting: Feasibility, safety, and mid-term outcome of the transabdominal off-pump technique using the right gastroepiploic artery.
abstract: OBJECTIVE
  Repeat sternotomy is associated with a substantial risk of cardiovascular injury. We evaluated the feasibility and clinical outcome of a transabdominal approach without sternotomy and without cardiopulmonary bypass in repeat coronary artery bypass grafting, using the right gastroepiploic artery to graft vessels of the inferior wall of the heart.
  
  
  METHODS
  From July 1999 to October 2010, 22 patients presenting with only right coronary artery disease underwent reoperation using the transabdominal approach and a skeletonized gastroepiploic artery graft. In all patients but 1, a patent graft to the anterior wall was present. The mean EuroSCORE was 6.4 ± 2.5.
  
  
  RESULTS
  All patients had adequate surgical exposure, and no conversion to sternotomy or the use of cardiopulmonary bypass was required. There was no in-hospital mortality. Hospital morbidity included pneumothorax in 1 patient and atrial fibrillation in 2 patients. The median hospital stay was 5 days. Follow-up was complete, and the median follow-up time was 6 years. There were 2 late deaths. Four patients experienced recurrence of angina, of whom three required percutaneous coronary intervention. The estimated freedom from major cardiovascular and cerebrovascular events rate was 70.2% at 6 years. Fourteen patients underwent an exercise stress test at a median interval of 2 years, with all showing no signs of myocardial ischemia.
  
  
  CONCLUSIONS
  Transabdominal off-pump coronary artery bypass grafting using the right gastroepiploic artery is a safe and effective procedure with low in-hospital mortality and morbidity and favorable mid-term outcome. In redo operations, this technique excludes the risk of cardiovascular injury.
authors: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. G.Tavilla@ctc.umcn.nl
authors: Giuseppe
authors: G
authors: Tavilla
authors: Eline F
authors: EF
authors: Bruggemans
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D024405:Gastroepiploic Artery / Q000637:transplantation*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D056346:Sternotomy; D016896:Treatment Outcome