Aorta-sparing total arterial redo-CABG using a recycled patent LIMA: a consecutive 24-patient series with midterm
Ahmad Ali Amirghofran1, Alireza Arzhangzadeh2, Soorena Khorshidi2
1Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Reusing a patent left internal mammary artery (LIMA) in redo coronary artery bypass grafting (Redo-CABG) is safe and effective for total arterial revascularization. This approach offers durable graft patency and avoids major adverse cardiac or cerebrovascular events in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Surgery
Background:
- Redo coronary artery bypass grafting (Redo-CABG) presents challenges due to complex anatomy and limited graft options.
- A previously patent left internal mammary artery (LIMA) can serve as a durable inflow source for total arterial revascularization (TAR).
Purpose of the Study:
- To evaluate the safety and midterm outcomes of reusing a patent LIMA as an inflow source in Redo-CABG.
- To assess the feasibility of TAR using a reused LIMA in patients with prior CABG.
Main Methods:
- Retrospective case series of 24 patients undergoing Redo-CABG with a patent LIMA.
- Confirmation of LIMA patency via angiography or CTA.
- Achieved complete TAR using arterial grafts (internal mammary and/or radial artery) anastomosed to the LIMA.
Main Results:
- Complete TAR was achieved in all patients with no hospital or 30-day mortality.
- Mean ejection fraction was 44.5%, with a mean ICU stay of 3.1 days.
- Midterm follow-up (median 3.5 years) showed complete graft patency and no major adverse cardiac or cerebrovascular events (MACCE).
Conclusions:
- Reusing a patent LIMA for TAR in Redo-CABG is a feasible and safe strategy for selected high-risk patients.
- This technique may reduce aortic manipulation, potentially lowering neurological risks.
- Further multicenter studies are needed to confirm superiority due to the retrospective, single-center design and small sample size.
Background:
Redo coronary artery bypass grafting (Redo-CABG) poses significant challenges due to complex coronary anatomy and limited conduit availability. In patients with a previously patent left internal mammary artery (LIMA), reusing it as an inflow source for total arterial revascularization (TAR) may offer a durable, stroke-sparing strategy. This study evaluated the safety and midterm outcomes of reusing a patent LIMA as an inflow source in Redo-CABG.
Methods:
This retrospective case series included 24 patients who underwent Redo-CABG at Faghihi and Dena Hospitals (Shiraz University of Medical Sciences) between March 2015 and October 2023. Consecutive patients were included to minimize selection bias. All patients had a patent LIMA confirmed by angiography or computed tomography angiography (CTA). Arterial grafts (right internal mammary and/or radial artery) were anastomosed to the patent LIMA to achieve complete TAR. Outcomes included perioperative complications, graft patency on CTA, and midterm major adverse cardiac or cerebrovascular events (MACCE).
Results:
All patients achieved complete TAR with no hospital or 30-day mortality. One patient required reoperation for bleeding. Mean postoperative ejection fraction was 44.5 ± 4.6%, and mean ICU stay was 3.1 ± 0.9 days. Early postoperative CT angiography (at 3 months) and midterm follow-up imaging (median 3.5 years; completed in a subgroup of 12 patients) demonstrated complete graft patency in all evaluated conduits, with no recorded MACCE.
Conclusions:
Reusing a patent LIMA as an inflow source for total arterial grafting in Redo-CABG appears to be a feasible and safe alternative for high-risk patients with limited conduit options. This approach minimizes extensive aortic manipulation, potentially offering a theoretical advantage in minimizing neurological risks. However, the retrospective, single-center design and small sample size preclude definitive conclusions regarding superiority, warranting further comparative evaluation in larger multicenter studies.
