Surgical Strategy for Reoperative Coronary Artery Bypass Grafting

(Department of Surgery II, Kochi Medical School, Kochi, Japan)

Seiichiro Wariishi Hideaki Nishimori Takashi Fukutomi
Katsushi Oda Atsushi Hata Takemi Handa
Shiro Sasaguri
Though the number of reoperative coronary artery bypass grafting procedures (re-CABG) is increasing, the operative results are still inferior to primary CABG. In the present study, we analyzed results of our two different procedures for re-CABG and estimated predominance of the LAST-MIDCAB (off-pump left anterior small thoracotomy minimally invasive direct coronary artery bypass) procedure in selected patients. From 1999 to 2001, 25 patients underwent re-CABG. The age of patients ranged from 56 to 82 years (mean 70 years). Re-CABG was performed due to the occlusion of existing grafts in 14 cases, progressive disease of previously ungrafted vessels in 6 and anastomotic stenosis of previously grafted vessels in 5. We performed off-pump LAST-MIDCAB in 15 patients, on-pump CABG via a median sternotomy in 9 and on-pump LAST-CABG in 1 which was converted due to RV injury during a re-sternotomy. In the LAST-MIDCAB group, the left internal thoracic artery was chosen as a graft to the LAD in 10 patients, the right gastroepiploic artery in 4 and the saphenous vein in 1. The operation time of the LAST-MIDCAB group was significantly shorter than that of the on-pump CABG group. Blood transfusion was necessary for only one patient in the LAST-MIDCAB group. Although many postoperative complications occurred in the on-pump CABG group, no major postoperative complication was seen in the LAST-MIDCAB group except one patient who sufferred from lung fibrosis, which led to shortness of the postoperative hospital stay. We conclude that LAST-MIDCAB is an alternative way to reduce operative morbidity in selected re-CABG cases.
@Jpn. J. Cardiovasc. Surg. 32F69 -74i2003)