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J Thorac Cardiovasc Surg 2003;125:1157-1158
© 2003 The American Association for Thoracic Surgery

Brief Communications

Thoracosternotomy for off-pump coronary artery bypass

Charles S. Drummond, III, MDa, Timothy B. Gilbert, MDb, Stephen W. Downing, MDa Baltimore, Md

From the Department of Surgery, Division of Cardiac Surgery,a and the Departments of Anesthesiology and Medicine,b University of Maryland School of Medicine, Baltimore, Md.

Received for publication May 19, 2002. Accepted for publication May 31, 2002. Address for reprints: Stephen W. Downing, MD, Cardiac Surgery, Suite N4W94, University of Maryland Medical System, 22 S Greene St, Baltimore, MD 21201 (E-mail: sdowning@smail.umaryland.edu).

The first 20% of the full text of this article appears below.

The use of off-pump coronary artery bypass grafting (OPCAB) techniques may reduce risk, particularly for high-risk patients.Go Go 1-2 However, many of the very patients who would benefit most from an OPCAB approach are the least tolerant of the requisite cardiac manipulation. We hypothesized that a left anterior thoracosternotomy (LATS) would reduce the amount of cardiac displacement (relative to a median sternotomy) required for exposure of lateral and inferior wall targets. This could facilitate OPCAB in patients with cardiomegaly and poor cardiac function that might render them relatively intolerant of conventional OPCAB techniques.

Patients and methods

In 8 patients a LATS incision was used for OPCAB when an off-pump technique was indicated but the patient's cardiomegaly and severely reduced ejection fraction made exposure of the obtuse marginal vessels difficult or not technically feasible. The heart was approached by way of a LATS through the fourth or fifth intercostal space. The incision crossed the sternum and extended 4 to 5 cm into the right side of the chest (Figure 1). The . . . [Full Text of this Article]






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