Reoperation for myocardial revascularization using the internal mammary artery
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Updated: Feb 24, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
R Gallotti1, G Mamolo, R Casucci
1Servizio di Diagnostica Medicina Nucleare, Ospedale Multizonale, Varese, Italy.
Insights
Redo myocardial revascularizations using internal mammary arteries (IMA) in 40 patients showed good long-term results. Most patients remained symptom-free after repeat bypass surgery, indicating IMA
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for coronary heart disease.
- Graft failure, particularly with saphenous vein grafts, often necessitates repeat revascularization procedures.
- Internal mammary arteries (IMA) are increasingly recognized for their durability in bypass surgery.
Purpose of the Study:
- To evaluate the outcomes of "redo" myocardial revascularizations using one or both internal mammary arteries (IMA).
- To assess the efficacy and safety of repeat coronary artery bypass grafting with IMA in patients with recurrent angina.
- To analyze the reasons for reoperation and the long-term symptom status after IMA-based redo CABG.
Main Methods:
- Retrospective analysis of 40 patients undergoing redo myocardial revascularizations between October 1984 and February 1989.
- Use of one or both internal mammary arteries (IMA) for bypass grafting.
- Assessment of indications for reoperation, including unstable angina and graft failure.
- Follow-up evaluation of symptom status, including angina frequency and exercise test results.
Main Results:
- The mean interval of angina recurrence was 48.5 months, with a mean interval of 68 months before the second bypass operation.
- Severe disease of previous vein grafts (25 patients) and progressive atherosclerosis (15 patients) were primary indications for reoperation.
- At a mean follow-up of 20.5 months, 28 patients (65%) were symptom-free, while 11 (25%) reported recurrent angina.
- One in-hospital mortality occurred due to cardiac arrest following bilateral pneumothorax; there were no late deaths.
Conclusions:
- Redo myocardial revascularization using internal mammary arteries (IMA) can achieve favorable long-term outcomes.
- IMA grafts demonstrate durability in repeat bypass surgery, offering a valuable option for patients with graft failure or progressive disease.
- Careful patient selection and surgical technique are crucial for successful redo CABG with IMA, with a significant proportion of patients remaining symptom-free postoperatively.
Abstract:
From October 1984 up to February 1989, 40 patients had "redo" myocardial revascularizations using one or both internal mammary arteries (IMA) in over 1000 cases operated upon in our Department for coronary bypass grafts. Thirty-one patients had a further operation for unstable angina difficult to control with drugs. Mean interval of recurrence of angina after previous surgery was 48.5 months for all the cases, but the mean interval before the second bypass operation was 68 months. Severe disease of previous vein grafts was the reason for surgery in 25 patients and progressive atherosclerosis in native coronary arteries in 15 patients. Twenty-one patients had a single mammary artery; both mammary arteries were used in 19. Two cases had endarterectomy on left anterior descending (LAD). Four patients had peroperative acute myocardial infarction (AMI), 3 a low cardiac output syndrome, postoperative bleeding occurred in 3 cases and wound infection in one case. An intraaortic balloon pump was used preoperatively in one case and coming off bypass in two others. One patient died on the second day postoperatively from cardiac arrest following bilateral pneumothorax. There were no late deaths. At a mean follow-up of 20.5 months, 28 patients are free of symptoms but 11 are complaining of angina, 5 during exercise and 6 at rest. An exercise test was positive in 8 patients.
