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Published on: March 27, 2018
[Re-operative Cardiac Surgery in Patients with Patent In Situ Coronary Artery Bypass Grafts]
Yasuhisa Fukada1, Yoshiki Endo, Akinobu Kitagawa
1Department of Cardiovascular Surgery, Iwaki City Medical Center, Iwaki, Japan.
Insights
A simplified approach to myocardial protection during redo cardiac surgery in patients with prior coronary artery bypass grafting (CABG) involving no in situ graft clamping is safe and effective. This technique avoids graft injury and ensures adequate cardiac protection.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Thoracic Surgery
Background:
- Re-operative cardiac surgery following coronary artery bypass grafting (CABG) presents significant challenges, particularly concerning in situ graft integrity and myocardial protection.
- Conventional methods involve dissecting and clamping in situ grafts, increasing the risk of catastrophic complications due to graft injury.
Purpose of the Study:
- To evaluate the safety and effectiveness of a simplified myocardial protection strategy in redo CABG patients with patent in situ grafts.
- To compare outcomes between a technique involving in situ graft clamping and one that avoids it.
Main Methods:
- A retrospective review of 25 redo CABG cases with patent in situ grafts was conducted.
- Patients were divided into two groups: Group C (18 patients) underwent in situ graft dissection and clamping, while Group U (7 patients) did not.
- Both groups received moderate hypothermia and cardioplegia for myocardial protection during aortic cross-clamping.
Main Results:
- No instances of in situ graft injury were observed in either group.
- Peak creatine kinase-MB levels, a marker of myocardial injury, showed no significant difference between the groups.
- Postoperative ejection fraction was preserved in all patients, indicating maintained cardiac function.
Conclusions:
- The simplified no-clamping technique offers a safe and effective alternative for myocardial protection in redo CABG patients with patent in situ grafts.
- This approach mitigates the risks associated with conventional graft manipulation, simplifying the procedure.
Background:
Re-operative cardiac surgery after prior coronary artery bypass grafting( CABG), using in situ graft is a challenge. Technical difficulties regarding this procedure include risks of graft injury and myocardial protection. The conventional strategy involves re-sternotomy, dissection, and temporary occlusion of the in situ graft to prevent cardioplegia washout. However, the problem with this procedure is that injury to the in situ graft can result in catastrophic complications.
Methods:
We reviewed 25 redo cases of patients who had prior CABG with patent in situ grafts. The in situ grafts were dissected and clamped in 18 (group C) patients, whereas in 7 (group U) patients, the in situ grafts were not dissected or clamped. All patients underwent re-sternotomy, aortic cross clamping and cardiac arrest with cardioplegia. Besides, myocardial protection was obtained using moderate hypothermia and systemic potassium injection in group U.
Results:
There were no injuries to the in situ grafts in either group. The peak creatine kinase-MB values were not significantly different between the two groups. Postoperative ejection fraction was preserved in both groups.
Conclusions:
The simplified approach of no-clamping technique yielded safety and effectiveness for myocardial protection in redo cases for patients with prior CABG in the presence of patent in situ grafts.
