Left thoracotomy approach in reoperative off-pump coronary revascularization

Bypass grafting from the left axillary artery or descending thoracic aorta
  • Masahito Minakawa
  • Kenji Takahashi
  • Norihiro Kondo
  • Masaharu Hatakeyama
  • Toshihiko Kuga
  • Ikuo Fukuda


Objective: Reoperative coronary bypass grafting is at high risk. Particularly in redo cases where the patent graft is running near the midline of the sternum, the graft may be exposed to injury by a median sternotomy and subsequent dissection. Whereas, off-pump bypass grafting from the left axillary artery or descending thoracic artery by a left thoracotomy approach is safe for preventing graft damage.Methods: From March 1998 to February 2002, we performed off-pump coronary artery bypass grafting by a left thoracotomy approach in 9 patients. The left axillary artery was used as the inflow vessel in 4 cases, and the descending thoracic, aorta in 5.Results: The radial artery was anastomosed proximally to the axillary artery in 4 cases and the descending thoracic aorta in one case. The saphenous vein graft was anastomosed, proximally to the descending thoracic aorta in 4 cases. Transdiaphragmatic minimally invasive bypass grafting for the right coronary artery was simultaneously performed in 3 cases. Postoperative cardiac events were ventricular arrhythmia in 6 cases and supraventricular arrhythmia in 3 cases. There was no damage to the patent grafts. Postoperative coronary angiography performed, in 8 cases revealed all the grafts to be patent without stenosis. Cardiac symptoms were not found after the operation in any of the cases.Conclusions: These procedures can prevent the injury to patent grafts caused by a median sternotomy, and will be one of the useful strategies for reoperative off-pump coronary artery bypass grafting.

Key words

thoracotomy axillary artery descending thoracic aorta coronary artery bypass off-pump bypass 


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  1. 1.
    Amano A, Hirose H, Takahashi A, Nagano N. Off-pump coronary artery bypass: Mid-term results. Jap J Thorac Cardiovasc Surg 2001; 49: 67–78.CrossRefGoogle Scholar
  2. 2.
    Knight WL, Baisden CE, Reiter CG. Minimally invasive axillary-coronary artery bypass. Ann Thorac Surg 1997; 63: 1776–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Bonatti J, Ladurner R, Hangler H, Katzgraber F. Anatomical studies concerning technical feasibility of minimally invasive axillocoronary bypass grafting. Eur J Cardiothorac Surg 1998; 14 (Suppl 1): S71–5.CrossRefGoogle Scholar
  4. 4.
    Magovern JA, Hunter TJ, Yoon PD. Clinical results with left axillary to left anteriordescending coronary artery bypass. Ann Thorac Surg 2001; 71: 561–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Baumgartner FJ, Gheissari A, Panagiotides GP, Capouya ER, Declusin GJ, Yokoyama T. Off-pump obtuse marginal grafting with local stabilization: Thoracotomy approach in reoperations. Ann Thorac Surg 1999; 68: 946–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Sinclair MC, LeBoutillier M 3rd, Gee W, Phillips T, Singer RL. Extra-anatomic redo of MIDCAB and OPCAB: An early experience. Heart Surg Forum 2000; 3: 127–32.PubMedGoogle Scholar
  7. 7.
    Trehan N, Mishra YK, Malhotra R, Sharma KK, Mehta Y, Shrivastava S. Off-pump redo coronary artery bypass grafting. Ann Thorac Surg 2000; 70: 1026–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Ide H, Fujiki T, Nonaka K, Ishida R, Imamura K, Sudo K. Reoperative coronary artery bypass via left thoracotomy. Jap J Thorac Cardiovasc Surg 2000; 48: 307–11.Google Scholar
  9. 9.
    Takahashi K, Minakawa M, Kondo N, Oikawa S, Hatakeyama M. Coronary artery bypass surgery by the transdiaphragmatic approach. Ann Thorac Surg 2002; 74: 700–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Minakawa M, Takahashi K, Kondo N, Hatakeyama M, Kuga T, Oikawa S. Minimally invasive direct coronary artery bypass performed via diaphragmatic approach. Jap J Thorac Surg 2001; 54: 288–92.PubMedGoogle Scholar
  11. 11.
    Kondo N, Takahashi K, Minakawa M, Oikawa S, Hatakeyama M. Coronary artery bypass via diaphragmatic approach with free graft. Ann Thorac Surg 2002; 74: 939–40.PubMedCrossRefGoogle Scholar
  12. 12.
    Neri E, Massetti M, Capannini G, Carone E, Tucci E, Dicolla F, et al. Axillary artery cannulation in type A aortic dissection operations. J Thorac Cardiovasc Surg 1999; 118: 324–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Whitlark JD, Goldman SM, Sutter FP. Axillary artery cannulation in acute ascending aortic dissections. Ann Thorac Surg 2000; 69: 1127–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Izumi Y, Yoshida H, Hasegawa S, Kubota H. Axillocoronary bypass in a patient with a severely atherosclerotic aorta. Jpn J Thorac Cardiovasc Surg 2000; 48: 652–4.PubMedGoogle Scholar
  15. 15.
    Bodner G. Beating heart axillocoronary bypass for management of the untouchable ascending aorta in coronary artery bypass grafting. Eur J Cardiothorac Surg 1999; 16 (Suppl 2): S18–23.Google Scholar
  16. 16.
    Bonatti J, Hangler H, Antretter H, Muller LC. Axillocoronary bypass for severely atherosclerotic aorta in coronary artery bypass grafting. J Thorac Cardiovasc Surg 1998; 115: 956–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Christenson JT, Schmuziger M. Sequential venous bypass grafts: Results 10 years later. Ann Thorac Surg 1997; 63: 371–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Lytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg 1985; 89: 248–58.PubMedGoogle Scholar
  19. 19.
    Mack MJ, Dewey TM, Magee MJ. Facilitated anastomosis for reoperative circumflex coronary revascularization on the beating heart through a left thoracotomy. J Thorac Cardiovasc Surg 2002; 123: 816–7.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Association for Thoracic Surgery 2003

Authors and Affiliations

  • Masahito Minakawa
    • 1
  • Kenji Takahashi
    • 1
  • Norihiro Kondo
    • 1
  • Masaharu Hatakeyama
    • 1
  • Toshihiko Kuga
    • 1
  • Ikuo Fukuda
    • 2
  1. 1.Department of Cardiovascular SurgeryAomori Rosai HospitalAomoriJapan
  2. 2.Department of Surgery IHirosaki University School of MedicineAomoriJapan

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