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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
[Reoperative cardiac surgery after previous coronary artery bypass grafting]
Yasunari Hayashi1, Toshiaki Ito, Atsuo Maekawa
1Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
Insights
Reoperative cardiac surgery after coronary artery bypass grafting (CABG) is feasible. Clamping the internal thoracic artery (ITA) graft from the left pleural space is safe, with ventricular fibrillation as a viable alternative.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Context:
- Reoperative cardiac surgery following coronary artery bypass grafting (CABG) is becoming more frequent.
- This study reviewed 25 cases of reoperative cardiac surgery, excluding re-CABG procedures.
Purpose:
- To evaluate the safety and efficacy of reoperative cardiac surgery after CABG.
- To assess different surgical approaches and techniques for managing patients requiring repeat cardiac procedures.
Summary:
- The study included 25 patients (15 male, 10 female, mean age 74.4 years) undergoing reoperations 6.3 years post-CABG.
- Procedures included aortic/mitral valve surgeries and total arch replacements, with sternotomy in 20 cases and thoracotomy in 5.
- Internal thoracic artery (ITA) grafts were used in 24 patients, with 22 patent grafts. Techniques included cardioplegic arrest with ITA clamping and perfused ventricular fibrillation. No significant differences in cardiopulmonary bypass time or peak creatine kinase MB (CK-MB) were observed between groups.
- Operative mortality was 4% (1/25).
Impact:
- Clamping the left internal thoracic artery (LITA) graft from the left pleural space is demonstrated as an easy and safe method.
- Perfused ventricular fibrillation with hypothermia is presented as a useful alternative when clamping a patent graft is challenging.
- Findings provide valuable insights for surgeons performing complex reoperative cardiac procedures after prior CABG.
Abstract:
Reoperative cardiac surgery after coronary artery bypass grafting( CABG) has been increasing. We reviewed 25 cases of reoperative cardiac surgery after CABG. Re-CABG was not included in this study. The patients consisted of 15 men and 10 women. The mean patient age was 74.4±6.3 years old. The reoperations were performed 6.3±5.1 years after CABG. They consisted of 7 aortic valve surgeries, 2 double valve surgeries, 12 mitral valve surgeries, and 4 total arch replacements. Resternotomy was performed in 20 cases, while right thoracotomy was performed in 5 cases. Internal thoracic artery( ITA)grafts had been used in 24 cases, and 22 of them were patent. Fifteen operations were performed under cardioplegic arrest with the patent ITA graft clamped from the left pleural space, while 5 operations were performed under perfused ventricular fibrillation with hypothermia. No differences were observed between the 2 groups in terms of cardiopulmonary bypass (CPB) time and peak creatine kinase MB (CK-MB). Operative mortality was 4% (1/25). To clamp left internal thoracic artery (LITA) graft from the left pleural space is easy and safe. In case clamping the patent graft is difficult, perfused ventricular fibrillation with hypothermia is a useful alternative.
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