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Ann Thorac Surg 2000;69:972
© 2000 The Society of Thoracic Surgeons

Correspondence

Reply

Fritz J. Baumgartner, MDa

a Pacific Cardiothoracic Surgery Group, Los Angeles, CA, USA

To the Editor

We thank Dr D’Ancona and associates for their kind comments and discussion of their extensive experience in marginal grafting through a thoracotomy approach in reoperations. One needs to remain cognizant in off-pump procedures that marginal grafting from the thoracotomy route is a good deal more difficult than grafting of the anterior wall vessels because of the distance of the marginal vessels from the lateral chest wall. Furthermore, it is not immune from the other complications of routine coronary revascularization. We recently learned that one of the patients in our study has developed severe, diffuse venous intimal hyperplasia resulting in occlusion of a marginal graft. The technique nonetheless remains useful in specific circumstances, and other groups have succeeded in the approach as well [1].

References

  1. Coulson A.S., Bakhshay S.A., Sloan T.J. Minimally invasive reoperation through a lateral thoracotomy for circumflex coronary artery bypass. Tex Heart Inst J 1998;25:170-174.[Medline]

Related Article

Thoracotomy approach in reoperations
Giuseppe D’Ancona, Hratch L. Karamanoukian, Jacob Bergsland, and Tomas A. Salerno
Ann. Thorac. Surg. 2000 69: 972. [Extract] [Full Text] [PDF]




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