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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 1, January/February 2015
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AFRICA
In our clinic, selected candidates for this procedure are
patients suffering from angina due to lesions in the Cx and its
branches, who are non-responsive to medical therapy and/or
with failure of PTCA/stent. All must have patent LITA–LAD
anastomoses. Other indications mentioned in the literature
for this procedure are: calcified ascending but not descending
aorta, sternum osteomyelitis or mediastinitis, mediastinal
irradiation, requirement of concomitant left lung surgery, and
previous mitral valve replacement, which creates a risk for atrio-
ventricular groove rupture while rotating the heart to approach
the arteries from the lateral aspect.
15,16
We believe that re-operative off-pump CABG, performed via
a left posterolateral thoracotomy to revascularise the Cx and
its branches eliminates the difficulties of median resternotomy,
in addition to the potential negative effects of bleeding and
embolisation due to cardiac and conduit injury during extensive
dissection of the heart. Avoiding resternotomy and CPB in
re-operative isolated CABG surgery decreases morbidity and
mortality rates.
4,5
Conclusion
In selected patients, off-pump re-operative CABG for the Cx
and its branches via a left posterolateral thoracotomy can
be performed with lower rates of morbidity and mortality in
addition to cost-effective consequences.
This study was presented at the 23rd World Congress of the World Society of
Cardiothoracic Surgeons, Split, from 12–15 September 2013.
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