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Updated: Apr 28, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Redo coronary artery bypass grafting
1Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan, yakuh@koto.kpu-m.ac.jp.
Insights
Redo coronary artery bypass grafting (CABG) is complex, with higher risks but improving outcomes. Long-term survival after redo CABG is comparable to percutaneous coronary intervention (PCI), guiding its limited use.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Interventional Cardiology
Background:
- Redo coronary artery bypass grafting (CABG) presents significant challenges compared to primary CABG.
- Patients undergoing redo CABG are typically older, have more comorbidities, and more advanced arterial disease.
- Decreasing rates of redo CABG are attributed to increased use of arterial grafts in primary procedures, percutaneous coronary intervention (PCI), and improved medical therapy.
Purpose of the Study:
- To review the challenges, outcomes, and evolving indications for redo CABG.
- To highlight technical advancements improving redo CABG results.
- To compare redo CABG outcomes with PCI.
Main Methods:
- Review of existing literature on redo CABG.
- Analysis of patient demographics and comorbidities in redo CABG populations.
- Evaluation of surgical techniques and myocardial protection strategies.
- Comparison of short-term and long-term outcomes of redo CABG versus PCI.
Main Results:
- Redo CABG involves greater complexity, including sternal reentry and myocardial dissection risks.
- In-hospital mortality for redo CABG is 2-5 times higher than primary CABG, though improving.
- Long-term survival after redo CABG is comparable to PCI.
- Technical refinements like retrograde cardioplegia and off-pump techniques have improved surgical results.
Conclusions:
- Redo CABG indications should be carefully selected, focusing on viable jeopardized left anterior descending (LAD) territory.
- CABG may be preferred over PCI in cases with extensive diseased vein grafts or low cardiac function.
- Ongoing technical advancements continue to enhance the safety and efficacy of redo CABG procedures.
Abstract:
Redo coronary artery bypass grafting (CABG) is more challenging than primary CABG in many aspects. Patients who undergo redo CABG are older, more comorbid, and with more sclerotic coronary and noncardiac arteries than seen in primary CABG. Operative procedures are more complicated, reentry of the sternum is sometimes problematic, and dissection of the heart is needed. If patent vein grafts are diseased, they can be sources of thromboembolism, and the patent left internal thoracic artery (ITA) anastomosed to the left anterior descending artery (LAD) must not be injured. The number of redo CABG procedures has been decreasing, because of frequent use of ITA to the LAD in primary CABG, aggressive percutaneous coronary intervention (PCI) by interventional cardiologists, and optimal medical therapy after primary CABG. In-hospital mortality in redo CABG is two to five times higher than that of primary CABG, although outcomes have been improving in recent years despite the patients' more comorbid background. Long-term survival after redo CABG is comparable to that of PCI. The indication for redo CABG should be limited to patients who have jeopardized LAD territory, which is viable. CABG is also preferable to PCI in patients with more diseased vein grafts and low cardiac function. Various technical refinements have also improved the surgical results of redo CABG. Retrograde cardioplegia greatly contributed to proper myocardial protection, especially when the occluded coronary arteries are supplied by patent in situ arterial grafts. The off-pump technique has been used in redo CABG and may be beneficial in a selected, more comorbid population.
