title: Reoperative coronary artery bypass surgery: avoiding repeat median sternotomy.
abstract: BACKGROUND
  Mortality and morbidity in reoperative coronary artery surgery are considered to be higher than those for initial surgery. Contributing factors include cardiac injury and damage to patent grafts in repeat median sternotomy. To avoid these complications, reoperative cases were performed off pump to avoid repeat median sternotomy.
  
  
  METHODS
  The study subjects were 79 patients who underwent reoperations while utilizing off-pump coronary artery bypass grafting to avoid the need for repeat median sternotomies. All operations were performed by the same surgeon in the period from January 1996 to December 2010.
  
  
  RESULTS
  The mean duration from initial surgery to reoperation was 6 years and 5 months. Reported reasons for reoperation were de novo coronary lesion in 16 patients, graft failure in 33 patients, and de novo coronary lesion plus graft failure in 47 patients. All cases underwent surgery off pump. The approach was left anterior small thoracotomy (35 patients), transdiaphragmatic approach (21 patients), left posterolateral thoracotomy (9 patients), left anterior small thoracotomy plus transdiaphragmatic approach (9 patients), left posterolateral thoracotomy plus transdiaphragmatic approach (4 patients), and small median sternotomy plus left anterior small thoracotomy (1 patient). There were no deaths among the 79 patients in whom repeat median sternotomy was avoided, and all grafts were patent.
  
  
  CONCLUSIONS
  Reoperative coronary artery surgery that avoids repeat median sternotomy can prevent cardiac injury and damage to patent grafts. Furthermore, it does not require blood transfusion. Thus, it is an effective method of reducing mortality and morbidity even in reoperative cases.
authors.affiliation: Department of Cardiovascular Surgery, Aomori Municipal Hospital, and Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan. takaken2171@yahoo.co.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Takahashi
authors.forename: Susumu
authors.initials: S
authors.lastname: Takeuchi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Ito
authors.forename: Mari
authors.initials: M
authors.lastname: Chiyoya
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kondo
authors.forename: Masahito
authors.initials: M
authors.lastname: Minakawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy; D015996:Survival Rate / Q000639:trends; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome