Abstract

Background: Re-operative coronary artery bypass grafting (CABG) in patients with contraindications to sternotomy presents a technical challenge. In this study we retrospectively reviewed our experience in a selected group of patient selection, operative technique, and early results in patients having redo-CABG by a thoracotomy with cardiopulmonary bypass (CPB) and without CPB. 

Methods: The purpose of this message is to provide immediate results re-myocardial revascularization through thoracotomy of 39 patients, who have return angina after previously CABG and design our algorithm for repeated operations. 

Results: Left thoracotomy is used in 32 (82%) patients: with CPB (n = 14) and without CPB (n = 9), (Figure 1 and 2). Right thoracotomy is used in 7 (18%) patients: with CPB (n = 2) and without CPB (n = 5). The CPB was carried out with the cannulment of the femoral artery and veins in conditions of normothermia. Multivessel CABG (2 or more) performed in 18 (46,1%) patients, CABG 1 arteries - in 21 (53,9%) patients. Intraoperative angiography, in the absence of contraindication, performed bypass (37 (94.8%) patients). There were 57 distal anastomoses performed for a mean of 1.5 grafts/patient. Targets approached included branches of the circumflex coronary artery (n = 20), diagonal (n = 3), RCA (n = 8) and the LAD (n = 25). Conclusion: Redo CABG via thoracotomy in patients with return angina after CABG lead to better direct results of surgical treatment: a decrease in the frequency of AMI, AHF, stroke, hospital mortality, reoperation about the bleeding, of post-operative transfusions, reducing the time of mechanical ventilation and bed-days. 

Keywords: Repeat Coronary Bypass Surgery; Thoracotomy; MICS; MIDCAB

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