The Preferred Approach for Mitral Valve Surgery after CABG: Right Thoracotomy, Hypothermia and Avoidance of LIMA-LAD Graft
John G. Byrne MD, Alexandros N. Karavas MD, David H. Adams MD, Lishan Aklog MD, Sary F. Aranki MD, Farzan Filsoufi MD, Lawrence H. Cohn MD

Right thoracotomy with moderate-deep hypothermia and fibrillatory arrest is the preferred approach for reoperative mitral valve surgery after coronary artery bypass grafting (CABG) in the presence of patent left internal mammary artery-left anterior descending coronary artery (LIMA-LAD) grafts. Thirty-seven consecutive right thoracotomy patients were compared with 10 consecutive patients operated on through re-sternotomy, aortic clamping and cardioplegic arrest. A lower incidence of injury of LIMA-LAD grafts was found, and lower perioperative blood requirements in patients operated on via a right thoracotomy.