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Hratch L. Karamanoukian
Tomas A. Salerno
Jacob Bergsland
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Ann Thorac Surg 2000;70:309-310
© 2000 The Society of Thoracic Surgeons

How to do it

Reoperative "off-pump" circumflex revascularization via left thoracotomy: how to prevent graft kinking

Marco Ricci, MD, PhDa, Hratch L. Karamanoukian, MDa, Giuseppe D’Ancona, MDa, Tomas A. Salerno, MDa, Jacob Bergsland, MDa

a Division of Cardiothoracic Surgery and the Center For Minimally Invasive Cardiac Surgery, Kaleida Health System and State University of New York at Buffalo, Buffalo, New York, USA

Address reprint requests to Dr Karamanoukian, Division of Cardiothoracic Surgery, The Buffalo General Hospital, 100 High St, Buffalo, NY 14203
e-mail: lisbon5{at}yahoo.com

Reoperative circumflex revascularization can be performed through a left thoracotomy approach, with or without cardiopulmonary bypass. In such cases, establishing the appropriate length of coronary grafts connecting the descending thoracic aorta to one of the marginal branches of the circumflex coronary artery may be problematic. In fact, if these grafts are too long they may kink, whereas if left too short they may be injured by respiratory excursions of the left lower lobe of the lung. In this report we describe a technique that can prevent these potential complications.




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