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Off-Pump Coronary Artery Bypass pp 163–174Cite as

Redo Operation

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Abstract

Redo coronary artery bypass grafting (CABG) has been associated with higher mortality and morbidity when compared with first-time CABG. The problems related to redo CABG include (1) sternal reentry, (2) injury to patent grafts or the heart during dissection, (3) atheromatous embolization from diseased vein grafts, (4) inadequate myocardial protection, (5) quality and availability of conduits, and (6) incomplete revascularization. In addition, the demographics of patients undergoing redo CABG have changed, including an increasing number of patients with patent arterial grafts and higher risk profiles. As off-pump coronary artery bypass grafting (OPCAB) has evolved over the past two decades, the off-pump procedure has been applied to redo coronary surgery. Several reports demonstrated that redo OPCAB reduced mortality and the incidence of perioperative myocardial infarction, cerebrovascular accident, and other complications. However, there is some evidence that redo OPCAB patients receive fewer distal grafts with less complete revascularization than redo conventional CABG patients. Alternative approaches to avoid repeat median sternotomy, such as (1) left anterior small thoracotomy (LAST), (2) left lateral thoracotomy, (3) the transdiaphragmatic approach, and (4) combination of the left thoracotomy and transdiaphragmatic approach, may reduce risks attributable to dissection of the heart and manipulation of patent or diseased grafts. This technique is a promising option for selective reoperative patients who have patent grafts and who are not candidates for conventional coronary reoperations.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-0022, Japan

    Yuji Maruyama

  2. Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Masami Ochi

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  1. Yuji Maruyama
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Correspondence to Yuji Maruyama .

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Editors and Affiliations

  1. Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan

    Tohru Asai

  2. Department of Cardiovascular Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan

    Masami Ochi

  3. Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Fukushima, Japan

    Hitoshi Yokoyama

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Maruyama, Y., Ochi, M. (2016). Redo Operation. In: Asai, T., Ochi, M., Yokoyama, H. (eds) Off-Pump Coronary Artery Bypass. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54986-4_21

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