[Redo coronary artery bypass operation under beating heart via the left thoracotomy reusing patent grafts]

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Techniques
• Minimally Invasive Cardiac Surgery

Background:

• Redo coronary artery bypass grafting (CABG) presents challenges, particularly with graft failure.
• Occlusion of saphenous vein grafts (SVG) is a common cause of angina recurrence after initial CABG.
• Alternative surgical approaches are needed for complex reoperative cardiac surgery.

Observation:

• Three cases of successful redo CABG using off-pump beating heart surgery via left thoracotomy are presented.
• Patients experienced angina recurrence due to proximal SVG occlusion, with patent distal SVG segments functioning as coronary-coronary bypass.
• A left internal thoracic artery graft (ITAG) remained patent to the left anterior descending coronary artery (LAD) in two cases.

Findings:

• Successful revascularization was achieved by utilizing patent graft segments and new arterial grafts (radial artery) in cases 1 and 2.
• Case 3 involved simultaneous reoperative CABG and pseudoaneurysm repair, with SVG used for bypass due to ITAG stricture.
• All patients experienced uneventful postoperative courses, highlighting the efficacy of these redo CABG strategies.

Implications:

• Left thoracotomy offers a minimally invasive approach for redo CABG, preserving sternal integrity.
• Recycling of previously implanted patent grafts and use of new arterial conduits are effective in revascularization.
• These techniques provide valuable options for managing recurrent graft failure and complex cardiac conditions.