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Safe approach for redo coronary artery bypass grafting--preventing injury to the patent graft to the left anterior descending artery.
Ann Thorac Cardiovasc Surg. 2010 Aug; 16(4):253-8.AT

Abstract

OBJECTIVE

In redo coronary artery bypass grafting (CABG), repeat median sternotomy is a routine approach when the graft to the left anterior descending artery (LAD) is occluded. However, it is important to avoid injury to the patent graft to LAD during repeat sternotomy. We retrospectively reviewed our cases to assess our combined strategy for a safer redo CABG.

METHODS

The study group comprised 19 patients (18 men and 1 woman; mean age 67.7 ± 6.9 years) who underwent redo CABG operations from January 2000 to August 2008. All patients had undergone median sternotomy during previous surgery (13 ± 6 years before repeat CABG). Eighteen patients had previous graft occlusion, and 6 had developed new coronary artery disease. Five patients had patent left internal thoracic artery (LITA) and 8 had patent saphenous vein graft (SVG). We attempted to avoid median sternotomy when patients had patent graft to LAD.

RESULTS

Median sternotomy (on-pump cardiac arrest) was performed on 13 patients with occluded graft to LAD. For those with the patent graft to LAD, left thoracotomy (on-pump beating) on 4 patients, and 2 patients underwent off-pump CABG via the subxiphoid approach. The mean number of bypass grafts was 2.6 ± 1.2. Internal thoracic arteries, radial arteries, saphenous vein graft, and gastroepiploic arteries were all selected as conduits. The ascending aorta, descending aorta, and previous SVG graft were used as the proximal anastomosis site. There was no graft injury, and 1 patient died as a result of ventricular tachycardia.

CONCLUSION

According to the circumstances, conduits and a proximal anastomosis should be selected. For redo CABG patients who have a patent graft to LAD, it is important to choose the optimal approach to avoid injury to the previous patent graft.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21057442

Citation

Nishi, Hiroyuki, et al. "Safe Approach for Redo Coronary Artery Bypass Grafting--preventing Injury to the Patent Graft to the Left Anterior Descending Artery." Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, vol. 16, no. 4, 2010, pp. 253-8.
Nishi H, Mitsuno M, Yamamura M, et al. Safe approach for redo coronary artery bypass grafting--preventing injury to the patent graft to the left anterior descending artery. Ann Thorac Cardiovasc Surg. 2010;16(4):253-8.
Nishi, H., Mitsuno, M., Yamamura, M., Tanaka, H., Ryomoto, M., Fukui, S., Yoshioka, Y., Takanashi, S., & Miyamoto, Y. (2010). Safe approach for redo coronary artery bypass grafting--preventing injury to the patent graft to the left anterior descending artery. Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 16(4), 253-8.
Nishi H, et al. Safe Approach for Redo Coronary Artery Bypass Grafting--preventing Injury to the Patent Graft to the Left Anterior Descending Artery. Ann Thorac Cardiovasc Surg. 2010;16(4):253-8. PubMed PMID: 21057442.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safe approach for redo coronary artery bypass grafting--preventing injury to the patent graft to the left anterior descending artery. AU - Nishi,Hiroyuki, AU - Mitsuno,Masataka, AU - Yamamura,Mitsuhiro, AU - Tanaka,Hiroe, AU - Ryomoto,Masaaki, AU - Fukui,Shinya, AU - Yoshioka,Yoshiteru, AU - Takanashi,Shunichiro, AU - Miyamoto,Yuji, PY - 2009/03/25/received PY - 2009/04/07/accepted PY - 2010/11/9/entrez PY - 2010/11/9/pubmed PY - 2011/4/22/medline SP - 253 EP - 8 JF - Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia JO - Ann Thorac Cardiovasc Surg VL - 16 IS - 4 N2 - OBJECTIVE: In redo coronary artery bypass grafting (CABG), repeat median sternotomy is a routine approach when the graft to the left anterior descending artery (LAD) is occluded. However, it is important to avoid injury to the patent graft to LAD during repeat sternotomy. We retrospectively reviewed our cases to assess our combined strategy for a safer redo CABG. METHODS: The study group comprised 19 patients (18 men and 1 woman; mean age 67.7 ± 6.9 years) who underwent redo CABG operations from January 2000 to August 2008. All patients had undergone median sternotomy during previous surgery (13 ± 6 years before repeat CABG). Eighteen patients had previous graft occlusion, and 6 had developed new coronary artery disease. Five patients had patent left internal thoracic artery (LITA) and 8 had patent saphenous vein graft (SVG). We attempted to avoid median sternotomy when patients had patent graft to LAD. RESULTS: Median sternotomy (on-pump cardiac arrest) was performed on 13 patients with occluded graft to LAD. For those with the patent graft to LAD, left thoracotomy (on-pump beating) on 4 patients, and 2 patients underwent off-pump CABG via the subxiphoid approach. The mean number of bypass grafts was 2.6 ± 1.2. Internal thoracic arteries, radial arteries, saphenous vein graft, and gastroepiploic arteries were all selected as conduits. The ascending aorta, descending aorta, and previous SVG graft were used as the proximal anastomosis site. There was no graft injury, and 1 patient died as a result of ventricular tachycardia. CONCLUSION: According to the circumstances, conduits and a proximal anastomosis should be selected. For redo CABG patients who have a patent graft to LAD, it is important to choose the optimal approach to avoid injury to the previous patent graft. SN - 2186-1005 UR - https://www.unboundmedicine.com/medline/citation/21057442/Safe_approach_for_redo_coronary_artery_bypass_grafting__preventing_injury_to_the_patent_graft_to_the_left_anterior_descending_artery_ L2 - https://medlineplus.gov/coronaryarterybypasssurgery.html DB - PRIME DP - Unbound Medicine ER -