Redo-Coronary Artery Bypass due to Progression of the Celiac Axis Stenosis

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Techniques
• Coronary Artery Disease Management

Background:

• Recurrent angina after initial coronary artery bypass grafting (CABG) necessitates re-evaluation of graft patency and coronary anatomy.
• Celiac axis stenosis can compromise flow to in situ grafts, potentially leading to graft failure and symptom recurrence.
• Assessing myocardial perfusion is crucial for determining the extent of ischemia and guiding revascularization strategies.

Observation:

• A 55-year-old male presented with recurrent angina 7 years after his first CABG.
• Coronary angiography revealed patent grafts, with faint visualization of the right gastroepiploic artery (RGEA) graft anastomosed to the posterior descending artery, alongside celiac axis stenosis.
• Myocardial single-photon emission computed tomography (SPECT) showed decreased inferior wall perfusion, indicating significant ischemia.

Findings:

• Redo-CABG was performed 10 years post-initial surgery due to aggravated angina and reduced myocardial perfusion.
• A saphenous vein graft was interposed between the right internal thoracic artery and the RGEA in situ grafts.
• Post-operative assessment indicated relief of angina and improved myocardial perfusion.

Implications:

• This case highlights the successful application of redo-CABG with a composite graft strategy in managing complex coronary artery disease with graft compromise.
• Interposition grafting can restore adequate blood flow and improve myocardial function in patients with challenging anatomy, such as celiac axis stenosis affecting in situ grafts.
• The findings suggest that revascularization with tailored graft configurations can be effective in patients experiencing graft failure and recurrent ischemia after prior CABG.