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Multimodality Targeted Approach in Redo Off-Pump Coronary Artery Bypass Surgery

Department of Cardiovascular Surgery
¹ Department of Cardiology
² Department of Anaesthesiology, Escorts Heart Institute and Research Centre, New Delhi, India

For reprint information contact: Yugal K Mishra, PhD Tel: 91 11 682 5000 Fax: 91 11 682 5013 email: dryugal{at}mantramail.com Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi 110025, India.

Records of 86 patients who underwent off-pump redo coronary revascularization between December 1997 and December 2000, were analyzed. Approaches included median sternotomy (47), anterolateral thoracotomy for left anterior descending artery and diagonal targets (35), posterolateral thoracotomy for the obtuse marginal with proximal anastomosis on descending aorta (3), and a combined subxiphoid-anterior thoracotomy approach (1) for right gastroepiploic artery-to-left anterior descending artery anastomosis. The mean age was 61.82 years. There were 2 (2.3%) operative deaths. Complications included perioperative myocardial infarction in 4 patients and reexploration for bleeding in one. Blood transfusion was required in 12 patients. The mean length of hospital stay was 5 ± 2 days. A multimodality targeted approach for off-pump redo coronary artery bypass offers a less invasive but safer method of myocardial revascularization, with decreased complications, lower blood product requirement, and early hospital discharge.

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