Free internal mammary artery graft reimplantation on the same vessel in repeat coronary revascularization

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Techniques
• Graft Management

Background:

• Repeat coronary artery bypass grafting (CABG) often presents challenges with graft availability and function.
• Internal mammary artery (IMA) grafts are known for long-term patency but may require complex management in reoperations.
• This case addresses the specific issue of a non-functioning free IMA graft in a patient needing re-CABG and mitral valve replacement.

Observation:

• A 62-year-old male patient required revision of a 3-vessel coronary artery bypass operation and mitral valve replacement.
• The existing free left internal mammary artery (LIMA) graft showed critical stenosis near the distal anastomosis, rendering it non-functional.
• The free LIMA graft itself was preserved, presenting an opportunity for reuse.

Findings:

• Skeletonization of the tortuous free LIMA graft provided the necessary length for successful reimplantation onto the same native vessel.
• The reimplanted free LIMA graft was reused successfully in the repeat CABG procedure.
• The patient experienced no signs of myocardial ischemia at 29 months postoperatively following the combined procedure.

Implications:

• This case demonstrates the feasibility and potential benefit of recycling a free IMA graft in repeat CABG surgery.
• Skeletonization is a valuable technique to optimize graft length for reimplantation in complex reoperative cardiac surgery.
• This represents the first reported instance of reimplanting a free IMA graft onto the same vessel in a re-CABG setting, offering a novel approach for graft salvage.