OBJECTIVE: @entity453 ( @entity453 ) is performed under direct vision without sternotomy or cardiopulmonary bypass. The technique is used in reoperative @entity1 through various incisions to revascularize one or two areas of the heart. The internal mammary artery, @entity432 , radial artery, or saphenous vein are used as graft conduits. METHODS: Anterior coronary targets are grafted with the internal mammary artery via a small anterior thoracotomy. Inferior coronary targets are grafted with the @entity432 via a small midline epigastric incision. Lateral coronary targets are grafted with radial artery or saphenous vein via a posterior thoracotomy. After partial heparinization, the @entity254 is facilitated by local coronary occlusion and stabilization. Graft follow-up consists of outpatient Doppler examination and selective recatheterization. RESULTS: Between January 1994 and August 1997, 81 @entity1 underwent reoperative @entity453 grafting. Twenty-one @entity1 (25.9%) had internal mammary grafting, 39 (48.2%) had gastroepiploic grafting, and 21 (25.9%) had lateral grafting with radial artery or saphenous vein. There were nine early @entity204 (four cardiac, five non-cardiac), five late @entity204 (three cardiac, two non-cardiac), and nine @entity583 in remaining @entity1 . Sixteen @entity1 underwent recatheterization; there were one graft occlusion, two graft stenoses, and eight anastomotic stenoses. Mean postoperative length of stay was 3.8 days. Ninety percent (55/61) of @entity1 are free of symptoms at a mean follow-up of 7.8 months (range 0-39). CONCLUSIONS: Reoperative @entity453 grafting avoids the risks of resternotomy, aortic manipulation, and cardiopulmonary bypass. The techniques yield an early patency rate of 94%, which includes eight @entity1 who had postoperative catheter-based interventions. Reoperative @entity453 grafting had lower rates of supraventricular @entity943 and transfusion when compared with conventional coronary artery bypass grafting, but did not offer an advantage for mortality, @entity64 or @entity583 . This 3-year experience suggests that while reoperative @entity453 grafting can effectively revascularize focal areas of the heart, @entity1 should be carefully selected to minimize operative risk.

Reoperative XXXX grafting: 3-year clinical experience.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction', 'myocardial infarctions'] @entity943 :: ('MESH:D001145', 'Disease') :: ['arrhythmia'] @entity254 :: ('MESH:C563598', 'Disease') :: ['anastomosis'] @entity432 :: ('MESH:D001157', 'Disease') :: ['gastroepiploic artery'] @entity453 :: ('MESH:D003324', 'Disease') :: ['MIDCAB', 'Minimally invasive direct coronary artery bypass'] @entity204 :: ('MESH:D003643', 'Disease') :: ['deaths']
@entity453 :: (MESH:D003324,Disease) :: ['MIDCAB']
