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Ann Thorac Surg 1994;57:123-125
© 1994 The Society of Thoracic Surgeons

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Articles

Right thoracotomy for reoperative right coronary artery bypass procedures

Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA

Accepted for publication February 19, 1993.

^_* Address reprint requests to Dr Smith, Duke University Medical Center, Box 3442, Durham, NC 27710.

The use of a right thoracotomy is a safe alternative approach for reentering the mediastinum for reoperative right coronary artery bypass grafting. This technique was used in 9 patients and allowed minimal dissection, reducing the risks of hemorrhage and injury to previously placed patent grafts. Cardiopulmonary bypass was used in 4 patients in whom myocardial protection was accomplished with systemic hypothermia. Right atrial cunnulation provided adequate venous return, with arterial inflow established via the femoral artery (n = 2) or ascending aorta (n = 2). In 5 patients, revascularizafion was accomplished by temporary coronary artery occlusion without cardiopulmonary support. There were no deaths, and postoperative recovery was not delayed. Postoperative chest drainage (mean ± standard deviation, 1,076 ± 718 mL) was significantly less (p < 0.01) than redo median sternotomy (1,352 ± 602 mL) in a similar population. Eight of 9 patients remain free of angina 29 ± 24.8 months postoperatively.

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