Off-pump coronary artery bypass grafting and transmyocardial laser revascularization via a left thoracotomy.

Off-pump coronary artery bypass grafting may be combined with adjunctive transmyocardial laser revascularization to optimize revascularization. This approach may be advantageous for high-risk patients, particularly those having undergone previous sternotomies. From October 2000 through May 2001, 17 patients (9 women and 8 men) underwent off-pump coronary artery bypass grafting and transmyocardial laser revascularization via a left thoracotomy. The patients had a mean age of 63 years and a mean ejection fraction of 0.33. All but 1 patient had undergone previous coronary surgery. In each patient, the heart was approached via a left thoracotomy through the 5th intercostal space, and 37 transmural channels, 1 mm in diameter, were each created with a single pulse of the carbon dioxide laser. Coronary artery bypass grafting was then performed with left internal thoracic artery or saphenous vein grafts. The follow-up period ranged from 2.1 to 9.3 months (mean, 6.2 months). The patients received 28 bypass grafts (mean, 1.6 grafts). Postoperatively, 2 patients required inotropic support. On day 8, 1 patient died of ventricular fibrillation. After a mean hospitalization of 7.7 days, the remaining patients were discharged, free of angina. At follow-up examination after a mean of 6 months (range, 2-9 months), 15 patients remained free of angina and one had mild angina. None had required further hospitalization. Performed via a left thoracotomy, off-pump coronary artery bypass grafting plus transmyocardial laser revascularization yielded an acceptable mortality rate, no major morbidity, and substantial angina relief in this carefully selected group of challenging, high-risk patients.