Complete revascularization using a patent left internal thoracic artery and variable arterial grafts in multivessel
Ho-Ki Min1, Young Tak Lee, Wook Sung Kim
1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
This study shows that using composite and sequential grafting with new arterial grafts and a patent left internal thoracic artery (LITA) is a safe and effective strategy for coronary artery bypass grafting reoperations (redo-CABG). This approach helps achieve complete revascularization when graft availability is limited.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Optimizing long-term results in coronary surgery requires arterial grafting and complete revascularization.
- Coronary artery bypass grafting reoperation (redo-CABG) presents challenges due to limited graft availability.
- A patent left internal thoracic artery (LITA) can be a valuable resource in redo-CABG procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of composite and sequential grafting in redo-CABG using a patent LITA.
- To analyze outcomes of redo-CABG when employing a minimal number of new arterial grafts combined with an existing LITA.
- To determine if this grafting strategy can achieve complete revascularization in complex redo-CABG cases.
Main Methods:
- Retrospective review of 10 patients who underwent redo-CABG with a patent LITA between January 2005 and October 2008.
- Construction of composite and sequential grafts using new arterial grafts (LITA, radial artery) and the in situ LITA.
- Performance of conventional CABG or on-pump beating-heart CABG, with a focus on distal anastomoses supplied by the LITA.
Main Results:
- No hospital deaths occurred; perioperative complications were infrequent and minor (1 patient each).
- The mean follow-up duration was 23.6 months, with one late death and no recurrent angina.
- Coronary imaging in 7 patients confirmed all anastomoses were patent, indicating successful revascularization.
Conclusions:
- Composite and sequential grafting utilizing a patent LITA is a safe and effective alternative for redo-CABG.
- This strategy facilitates complete revascularization in patients with multivessel disease undergoing repeat coronary artery bypass surgery.
- The use of existing arterial grafts, like LITA, in conjunction with new grafts optimizes outcomes in redo-CABG.
Background:
Arterial grafting and complete revascularization are important requirements of coronary surgery to achieve optimum long-term results. In cases involving coronary artery bypass grafting reoperation (redo-CABG), it is sometimes difficult to satisfy these requirements because of the limited availability of grafts. In this study, we constructed composite and sequential grafting with a minimal number of new arterial grafts and a patent left internal thoracic artery (LITA), which sometimes is encountered in preoperative angiography, and we analyzed the results of redo-CABG.
Methods:
Between January 2005 and October 2008, 29 patients underwent redo-CABG. Ten patients who had a patent LITA graft in situ were reviewed retrospectively. We performed conventional CABG in 8 patients and on-pump beating-heart CABG in 2 patients. The new arterial grafts for the composite grafts included 7 LITAs and 3 radial arteries. The types of composite grafts included 7 Y grafts, 1 K graft, 1 X graft, and 1 double-Y graft. Overall, we performed 28 distal anastomoses (mean per patient, 2.8 +/- 0.7), of which 18 anastomoses were supplied from a patent LITA (mean, 1.8 +/- 0.4).
Results:
No hospital deaths occurred, and perioperative complications included injury to a LITA, low cardiac output, delirium, and postoperative bleeding in 1 patient each. The mean duration of follow-up was 23.6 +/- 16.8 months (range, 2-46 months). There was 1 late death and no recurrent angina during the follow-up period. Follow-up coronary images obtained for 7 patients showed that all of the anastomoses were patent.
Conclusion:
Composite and sequential grafting with new arterial grafts and a patent LITA is a safe and effective alternative in patients with multivessel disease undergoing redo-CABG.
