The Left Thoracotomy Approach for Reoperative Cardiac Surgery: Considerations for the Surgeon and Anesthesiologist

Abstract

w l E a p a p w d w c i d p w u o p c w i d o d f t fl w c o l f w t T d AGROWING NUMBER of patients are presenting for reoperative cardiac surgery after prior coronary artery byass graft (CABG) surgery.1 One common reason is the need or repeat coronary revascularization because of the progresion of native coronary artery disease or from failure of previus saphenous vein grafts (SVGs). Other indications include ortic valve replacement for aortic stenosis (AS) and mitral alve repair for ischemic mitral regurgitation.1,2 A repeat sterotomy traditionally has been the surgical approach of choice n these patients. However, this becomes more challenging hen a patent left internal mammary artery (LIMA) graft rosses the midline. In this context, sternal re-entry carries a rohibitive risk of injury to the graft, which often is associated ith a fatal outcome. This can be obviated in reoperative mitral alve surgery for which a right thoracotomy approach is a ell-known alternative.1 However, this becomes unfeasible hen concomitant revascularization of the posterolateral wall lso is required. Instead, the left thoracotomy offers considerble utility. Although there are limited case reports and small eries regarding its use in reoperative cardiac surgery,3-9 it emains a versatile approach for a variety of interventions. erein the authors describe 3 scenarios that show its applicaion in both coronary revascularization and valve surgery and ighlight particular features that are germane to each proceure.