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Use of MIDCAB procedure for redo coronary artery bypass
S Pascucci1, L Günkel, T Zietak
1Department of Cardiovascular Surgery, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany. pascucci.sandro@herzzentrum.de
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) offers a safe alternative for redo-coronary artery bypass grafting (CABG). This technique using internal mammary artery grafts shows low morbidity and mortality in selected patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Cardiac Reoperations
Background:
- Reoperative coronary artery bypass grafting (CABG) is increasingly common.
- Conventional redo-CABG procedures carry higher risks of mortality and morbidity.
- Minimally invasive direct coronary artery bypass (MIDCAB) may reduce these risks in select patients.
Purpose of the Study:
- To evaluate the safety and efficacy of MIDCAB using the left internal mammary artery (LIMA) for redo-CABG.
- To assess outcomes including mortality, morbidity, operation time, and hospital stay.
Main Methods:
- Retrospective review of 20 male patients undergoing redo-CABG via LIMA to left anterior descending (LAD) bypass.
- Procedure performed using lateral minithoracotomy on a beating heart.
- Concomitant percutaneous transluminal coronary angioplasty (PTCA) was performed in two patients.
Main Results:
- Mean operation time was 139 minutes.
- No deaths, myocardial infarctions, or need for re-exploration for bleeding occurred.
- All patients were mobilized early, discharged promptly, and remained alive and asymptomatic (CCS class I or II) postoperatively.
Conclusions:
- MIDCAB with internal mammary artery grafts is a safe and effective option for selected patients requiring redo-CABG.
- This technique presents a low-risk alternative to conventional redo-CABG when complete revascularization is not the primary goal.
Background:
Reoperative coronary artery bypass grafting (CABG) procedures are growing in importance due to the increasing number of patients requiring another bypass operation. Conventional redo-procedures are associated with an increased mortality and morbidity. To reduce risk, minimally invasive direct coronary artery bypass (MIDCAB) using the left internal mammary artery (LIMA) to the left anterior descending branch (LAD) may be preferable, when indicated, in selected patients. We report a series of patients who underwent this procedure for redo-CABG in our center.
Methods:
Since April 1997, 20 male patients who had undergone prior CABG using conventional procedure, were reoperated using the LIMA to LAD through a lateral minithoracotomy on the beating heart. Nineteen patients presented for a redo-CABG; one patient required a second-time redo-CABG. Two patients required concomitant PTCA of a second vessel as hybrid procedure. We reviewed these redo cases and studied their surgical results for mortality, morbidity, operation time, and hospital stay.
Results:
Mean operation time was 139 min (90-180). Four patients were extubated directly postoperatively; the others had a short period of ventilatory support. There was no myocardial infarction, no deaths or need of inotropic support postoperatively. No patient required re-exploration for bleeding. All patients could be mobilized and discharged early. At present, all patients are living and classified as CCS class I or II.
Conclusions:
Our results indicate that MIDCAB using IMA grafts for reoperation is a safe procedure with low risk for morbidity and mortality. This surgical technique is a useful alternative to conventional redo CABG in selected patients when complete revascularisation is not indicated.
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