ABSTRACT 57

OFF-PUMP REOPERATIVE CORONARY ARTERY BYPASS GRAFTING VIA THORACOTOMY: PATIENT SELECTION AND OPERATIVE TECHNIQUE

Fouad M. Azoury, MD, A. Marc Gillinov, MD, Bruce W. Lytle, MD, Nicholas G. Smedira, MD, Joseph F. Sabik, MD
The Cleveland Clinic Foundation, Cleveland, OH, USA

Purpose.Toreview our experience with redo-CABG via thoracotomy without cardiopulmonary bypass (CPB).

Methods. From 1996 to 1999, 1373 patients (pts) had redo-CABG; of these, 34 (2.5%) had redo-CABG off-pump via thoracotomy.  The primary indication for this approach was patent graft at risk for injury by resternotomy (60%).  Fifty-six percent were in New York Heart Association (NYHA) functional class III or IV.  A lateral thoracotomy was used in 21 pts, and 13 had an anterior thoracotomy.

Results.No pt required sternotomy or CPB. There were no hospital deaths. Seven of 8 grafts studied early were patent.  Follow-up was complete with a mean interval of 19 + 13 months. Three year actuarial survival was 72%.  Ninety percent of surviving pts are in NYHA functional class I or II.

Conclusion.This approach was associated with no mortality, low morbidity, satisfactory graft patency, and favorable mid-term symptomatic improvement.  Redo-CABG via thoracotomy without CPB is the approach of choice when resternotomy and/or CPB are undesirable, and theculprit coronary vessels are accessible via thoracotomy.