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Reoperative coronary artery bypass surgery: avoiding repeat median sternotomy.
Ann Thorac Surg. 2012 Dec; 94(6):1914-9.AT

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+Show Affiliations

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.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23026407

Citation

Takahashi, Kenji, et al. "Reoperative Coronary Artery Bypass Surgery: Avoiding Repeat Median Sternotomy." The Annals of Thoracic Surgery, vol. 94, no. 6, 2012, pp. 1914-9.
Takahashi K, Takeuchi S, Ito K, et al. Reoperative coronary artery bypass surgery: avoiding repeat median sternotomy. Ann Thorac Surg. 2012;94(6):1914-9.
Takahashi, K., Takeuchi, S., Ito, K., Chiyoya, M., Kondo, N., & Minakawa, M. (2012). Reoperative coronary artery bypass surgery: avoiding repeat median sternotomy. The Annals of Thoracic Surgery, 94(6), 1914-9. https://doi.org/10.1016/j.athoracsur.2012.07.007
Takahashi K, et al. Reoperative Coronary Artery Bypass Surgery: Avoiding Repeat Median Sternotomy. Ann Thorac Surg. 2012;94(6):1914-9. PubMed PMID: 23026407.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reoperative coronary artery bypass surgery: avoiding repeat median sternotomy. AU - Takahashi,Kenji, AU - Takeuchi,Susumu, AU - Ito,Kazuo, AU - Chiyoya,Mari, AU - Kondo,Norihiro, AU - Minakawa,Masahito, Y1 - 2012/09/28/ PY - 2012/02/02/received PY - 2012/06/28/revised PY - 2012/07/03/accepted PY - 2012/10/3/entrez PY - 2012/10/3/pubmed PY - 2013/1/30/medline SP - 1914 EP - 9 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 94 IS - 6 N2 - 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. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/23026407/Reoperative_coronary_artery_bypass_surgery:_avoiding_repeat_median_sternotomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(12)01618-9 DB - PRIME DP - Unbound Medicine ER -