Reoperative median sternotomy following the use of a right internal mammary artery pedicle graft crossing the midline to the left anterior descending artery

Journal of Cardiac Surgery
Takeshi KinoshitaTomoaki Suzuki

Abstract

The purpose of the present study was to examine the outcomes of cardiac reoperations for the patients with a previously placed pedicled graft of the right internal thoracic artery (RITA) to the left anterior descending artery (LAD). Of 1002 consecutive patients who underwent isolated coronary bypass surgery, 612 patients received pedicled grafts of skeletonized RITA to the LAD crossing the midline over the aorta. Of this cohort, seven patients underwent cardiac reoperations via a median resternotomy including aortic valve replacement, mitral valve plasty, and total arch replacement. Covering the RITA with pericardium and mediastinal tissue had been routinely performed in the initial operation. Preoperative computed tomography (CT) angiography showed the RITA at a safe distance from the sternum in six patients. No graft injury occurred during dissection. The patient who underwent emergent total arch replacement died from global brain ischemia at postoperative day 11. The remaining six patients recovered well without major complication and survived at 7.5 ± 4.5 years after reoperations. Cardiac reoperation via a median sternotomy can be performed at acceptable risk in patients with the RITA graft crossing the midline. Specific ma...Continue Reading

References

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Sep 28, 2010·The Annals of Thoracic Surgery·Takeshi KinoshitaKeiji Matsubayashi

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Citations

Nov 29, 2020·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Mario F L GaudinoUNKNOWN Coronary Task Force of the European Association for Cardio-Thoracic Surgery

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