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Ann Thorac Surg 2002;73:784
© 2002 The Society of Thoracic Surgeons

Invited commentary

^a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA

e-mail: gillinom@ccf.org

Reoperative cardiac surgery in the presence of a patent left internal thoracic artery (LITA) to left anterior descending (LAD) coronary artery bypass graft is increasingly common. The surgical challenges in this setting are to avoid damaging the LITA, secure myocardial protection, and accomplish the surgical mission.

Doctor Byrne and colleagues describe a strategy for management of a patent LITA-LAD graft in reoperations for aortic valve replacement. Their policy was to establish cardiopulmonary bypass via peripheral cannulation prior to the sternotomy. Once the sternotomy was accomplished, they did not attempt . . . [Full Text of this Article]

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