Thoracoscopic mammary artery mobilization in redo minimally invasive coronary bypass operations.

Abstract

It has been stated that thoracoscopic internal thoracic artery (ITA) mobilization is not recommended in the redo minimally invasive direct coronary artery bypass (MIDCAB) situation, presumably because adhesions from the previous coronary artery bypass grafting operation may preclude a thoracoscopic approach. However, there are advantages to thoracoscopic ITA mobilization in MIDCAB that could also be realized in the redo situation. In 200 MIDCAB procedures over the last 3 and a half years, 11 patients, ages 49-83 (mean 69), were identified as having undergone an attempted ITA mobilization in a redo situation. Thoracoscopic ITA mobilization was successful in 9 out of 11 patients (81%). One patient had complete pleural symphysis precluding this approach, and 1 patient had poor mammary flow after harvest and this conduit was not used. Both failures were in female octogenarians. To realize the advantages of a thoracoscopic ITA mobilization MIDCAB, both right and left thoracoscopic ITA mobilization can safely be performed in the redo situation. Thoracic adhesions precluding a thoracoscopic approach were encountered in only 1 of 11 redo coronary artery bypass grafting patients.