[Re-coronary artery bypass grafting using a MIDCAB technique in a patient with a patent RITA-LAD graft]

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Vascular Grafting

Background:

• Repeat coronary artery bypass grafting (re-CABG) with median sternotomy poses significant risks, especially in patients with existing patent grafts.
• A patent right internal thoracic artery-left anterior descending artery (RITA-LAD) graft presents unique challenges for re-revascularization.
• Minimally invasive techniques are sought to reduce morbidity associated with re-sternotomy.

Observation:

• A 56-year-old male with a history of four-vessel CABG presented with critical stenosis distal to a patent RITA-LAD graft.
• Conventional re-CABG via re-median sternotomy was deemed high-risk.
• The patient had a patent RITA-LAD graft from a previous surgery.

Findings:

• A novel re-CABG procedure was successfully performed using the right gastroepiploic artery-left anterior descending artery (RGEA-LAD) graft via the minimally invasive direct coronary artery bypass (MIDCAB) technique.
• This approach avoided re-median sternotomy and cardiopulmonary bypass.
• The RGEA was harvested through a small laparotomy and anastomosed to the LAD via a small thoracotomy.

Implications:

• Minimally invasive direct coronary artery bypass (MIDCAB) using the right gastroepiploic artery (RGEA) is a viable and potentially safer option for re-revascularizing the left anterior descending artery (LAD) in patients with a patent RITA-LAD graft.
• This technique may reduce the risks associated with repeat sternotomy and cardiopulmonary bypass in complex re-CABG cases.
• The RGEA serves as a valuable alternative conduit for arterial revascularization in challenging re-do CABG scenarios.