Left thoracotomy reoperation for coronary artery disease.

Twenty patients underwent reoperative coronary artery bypass grafting (CABG) through a left thoracotomy since 1971. This was their second CABG in 16 patients, third in three patients and fourth in one patient. Surgery was performed from 1 to 16 years following the initial procedure. Demographic data showed no significant variation from patients undergoing standard reoperative CAGB in this institution. Ejection fraction varied between 30% and 73%. Cardiopulmonary bypass technic has gradually developed since 1971, using the left femoral artery and vein. For venous cannulation a 50-cm long catheter was positioned in the right atrium. Monitoring included pulmonary artery catheter with oximetry. Fibrillatory arrest of the heart was utilized with 18-33 degrees C core cooling cardioplegia. The left internal mammary artery (6) and reverse saphenous veins (44) were used for an average of 2.5 grafts per patient. The proximal anastomosis was placed on the descending thoracic aorta or the left subclavian artery. There were two early and no late deaths. Sixteen patients were restudied before discharge from the hospital with an early graft patency rate of 98% (41/42). The left thoracotomy approach may be preferable in selected cases of redo CABG. The danger of damage to the heart and patent grafts is greatly reduced.