New approaches to redo-coronary bypass grafting

Patients presenting with recurrent symptoms after coronary artery bypass graft surgery (CABG) continue to be a significant therapeutic challenge for the interventional cardiologist and cardiac surgeon. Percutaneous transcatheter angioplasty and repeat CABG, directed at vein graft degeneration and progression of native atherosclerotic disease, carry substantially worse outcomes than primary procedures. Recent minimally invasive, surgical advances using minimal-access incisions, arterial conduits, and off-pump techniques are demonstrating improved hospital outcomes compared with conventional CABG. These sternotomy-sparing, beating heart surgical approaches combined with recent advances in drug-eluting stents to provide complete revascularization may provide the best cardiac event-free survival for symptomatic CABG patients in the future.