The preferred approach for mitral valve surgery after CABG: right thoracotomy, hypothermia and avoidance of LIMA-LAD graft.

摘要: Background and aim of the study An alternative to avoid redo sternotomy in patients with patent left internal mammary artery-left anterior descending coronary artery (LIMA-LAD) grafts undergoing mitral valve surgery is right thoracotomy moderate-deep hypothermia (approximately 20 degrees C) fibrillatory arrest without aortic cross-clamping. Few reports exist which directly compare re-sternotomy thoracotomy. Methods Between July 1992 February 2000, 47 (39 males, eight females; median age 66 years; range: 41-83 41 NYHA class III or IV) LIMA-LAD underwent surgery. Thirty-seven were approached through a (median (right group), 10 re-sternotomy, cross-clamping cardioplegic arrest. The ejection fraction was 42% (range: 20-71%). Univariate analysis used determine predictors outcome, as well evaluate differences characteristics between groups. Results Operative mortality (OM) perioperative myocardial infarction for entire cohort 11% 10%, respectively, there no inter-group differences. No preoperative associated OM. Two graft injuries occurred group compared none (20% versus 0%, p = 0.04). Transfusion requirements also greater 7 2 packed red blood cell units, Conclusion Right preferred approach reoperative after bypass grafting presence grafts. These data suggest that this decreased incidence injury, reduced transfusion requirements.