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Redo coronary artery bypass grafting

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Abstract

Redo coronary artery bypass grafting (CABG) is more challenging than primary CABG in many aspects. Patients who undergo redo CABG are older, more comorbid, and with more sclerotic coronary and noncardiac arteries than seen in primary CABG. Operative procedures are more complicated, reentry of the sternum is sometimes problematic, and dissection of the heart is needed. If patent vein grafts are diseased, they can be sources of thromboembolism, and the patent left internal thoracic artery (ITA) anastomosed to the left anterior descending artery (LAD) must not be injured. The number of redo CABG procedures has been decreasing, because of frequent use of ITA to the LAD in primary CABG, aggressive percutaneous coronary intervention (PCI) by interventional cardiologists, and optimal medical therapy after primary CABG. In-hospital mortality in redo CABG is two to five times higher than that of primary CABG, although outcomes have been improving in recent years despite the patients’ more comorbid background. Long-term survival after redo CABG is comparable to that of PCI. The indication for redo CABG should be limited to patients who have jeopardized LAD territory, which is viable. CABG is also preferable to PCI in patients with more diseased vein grafts and low cardiac function. Various technical refinements have also improved the surgical results of redo CABG. Retrograde cardioplegia greatly contributed to proper myocardial protection, especially when the occluded coronary arteries are supplied by patent in situ arterial grafts. The off-pump technique has been used in redo CABG and may be beneficial in a selected, more comorbid population.

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References

  1. Cosgrove DM, Loop FD, Lytle BW, Gill CC, Golding LA, Gibson C, Stewart RW, Taylor PC, Goormastic M. Predictors of reoperation after myocardial revascularization. J Thorac Cardiovasc Surg. 1986;92:811–21.

    CAS  PubMed  Google Scholar 

  2. Sergeant P, Blackstone E, Meyns B, Stockman B, Jashari R. First cardiological or cardiosurgical reintervention for ischemic heart disease after primary coronary artery bypass grafting. Eur J Cardiothorac Surg. 1998;14:480–7.

    Article  CAS  PubMed  Google Scholar 

  3. Keogh BE, Kinsman R. National adult cardiac surgical database report 2000–2001. Society of cardiothoracic surgeons of Great Britain and Ireland. Henley-on-Thames: Dendrite Clinical Systems Ltd; 2002.

  4. Sabik JF III, Raza S, Blackstone EH, Houghtaling PL, Lytle BW. Value of internal thoracic artery grafting to the left anterior descending coronary artery at coronary reoperation. J Am Coll Cadiol. 2013;61:302–10.

    Article  Google Scholar 

  5. Amano J, Kuwano H, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2011. Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2013;2013(61):578–607.

    Article  Google Scholar 

  6. Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS. Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features. Circulation. 2004;109:2290–5.

    Article  PubMed  Google Scholar 

  7. Morrison DA, Sethi G, Sacks J, Henderson W, Grover F, Sedlis S, Esposito R, Ramanathan K, Weiman D, Saucedo J, Antakli T, Pramesh V, Pett S, Vernon S, Birjiniuk V, Welt F, Krucoff M, Wolfe W, Lucke JC, Mediratta S, Booth D, Barbiere C, Lewis D. Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter randomized trial. Investigators of the Department of Veterans Affairs Cooperative Study #385, the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME). J Am Coll Cardiol. 2001;38:143–9.

    Article  CAS  PubMed  Google Scholar 

  8. Morrison DA, Sethi G, Sacks J, Henderson WG, Grover F, Sedlis S, Esposito R. Percutaneous coronary intervention versus repeat bypass surgery for patients with medically refractory myocardial ischemia: AWESOME randomized trial and registry experience with post-CABG patients. J Am Coll Cardiol. 2002;40:1951–4.

    Article  PubMed  Google Scholar 

  9. Subramanian S, Sabik JF 3rd, Houghtaling PL, Nowicki ER, Blackstone EH, Lytle BW. Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending. Ann Thorac Surg. 2009;87:1392–8.

    Article  PubMed  Google Scholar 

  10. Kolh P, Wijns W, Danchin N, Di Mario C, Falk V, Folliguet T, Garg S, Huber K, James S, Knuuti J, Lopez-Sendon J, Marco J, Menicanti L, Ostojic M, Piepoli MF, Pirlet C, Pomar JL, Reifart N, Ribichini FL, Schalij MJ, Sergeant P, Serruys PW, Siber S, Uva MS, Taggart D. Guidelines on myocardial revascularization. Eur J Cardiothorac Surg. 2010;38(Suppl):S1–52.

    Article  PubMed  Google Scholar 

  11. Gonzalez-Stawinski GV, Lytle BW. Coronary artery reoperations. In: Cohn LH, editor. Cardiac surgery in the adult. 4th ed. New York: The McGraw-Hill Companies; 2012.

    Google Scholar 

  12. Lytle BW, McElroy D, McCarthy P, Loop FD, Taylor PC, Goormastic M, Stewart RW, Cosgrove DM. Influence of arterial coronary bypass grafts on the mortality in coronary reoperations. J Thorac Cardiovasc Surg. 1994;107:675–82.

    CAS  PubMed  Google Scholar 

  13. Ghanta RK, Kaneko T, Gammie JS, Sheng S, Aranki SF. Evolving trends of reoperative coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg. 2013;145:364–72.

    Article  PubMed  Google Scholar 

  14. Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986;314:1–6.

    Article  CAS  PubMed  Google Scholar 

  15. Turner FE, Lytle BW, Navia D, Loop FD, Taylor PC, McCarthy PM, Stewart RW, Rosenkranz ER, Cosgrove DM 3rd. Coronary reoperation: results of adding an internal mammary artery graft to a stenotic vein graft. Ann Thorac Surg. 1994;58:1353–5.

    Article  CAS  PubMed  Google Scholar 

  16. Weintraub WS, Jones EL, Craver JM, Grosswald R, Guyton RA. In-hospital and long-term outcome after reoperative coronary artery bypass graft surgery. Circulation. 1995;92(9 Suppl):II-50–7.

    Article  CAS  Google Scholar 

  17. Akins CW, Buckley MJ, Daggett WM, Hilgenberg AD, Vlahakes GJ, Torchiana DF, Austen W. Reoperative coronary grafting: changing patient profiles, operative indications, techniques, and results. Ann Thorac Surg. 1994;58:359–64.

    Article  CAS  PubMed  Google Scholar 

  18. Perrault L, Carrier M, Cartier R, Leclerc Y, Hebert Y, Diaz OS, Pelletier C. Morbidity and mortality of reoperation for coronary artery bypass grafting: significance of atheromatous vein grafts. Can J Cardiol. 1991;7:427–30.

    CAS  PubMed  Google Scholar 

  19. Yap C-H, Sposato L, Akowuah E, Theodore S, Dinh DT, Shardey GC, Skillington PD, Tatoulis J, Yii M, Smith JA, Mohajeri M, Pick A, Seevanayagam S, Reid CM. Contemporary results show repeat coronary artery bypass grafting remains a risk factor for operative mortality. Ann Thorac Surg. 2009;87:1386–91.

    Article  PubMed  Google Scholar 

  20. Cole JH, Jones EL, Craver JM, Guyton RA, Morris DC, Douglas JS, Ghazzal Z, Weintraub WS. Outcomes of repeat revascularization in diabetic patients with prior coronary surgery. J Am Coll Cardiol. 2002;40:1968–75.

    Article  PubMed  Google Scholar 

  21. Dougenis D, Brown AH. Long-term results of reoperations for recurrent angina with internal mammary artery versus saphenous vein grafts. Heart. 1998;80:9–13.

    CAS  PubMed Central  PubMed  Google Scholar 

  22. Higami T, Kozawa S, Asada T, Shida T, Ogawa K. Skeletonization and harvest of the internal thoracic artery with an ultrasonic scalpel. Ann Thorac Surg. 2000;70:307–8.

    Article  CAS  PubMed  Google Scholar 

  23. Navia D, Cosgrove DM 3rd, Lytle BW. Is the internal thoracic artery the conduit of choice to replace a stenotic vein graft? Ann Thorac Surg. 1994;57:40–4.

    Article  CAS  PubMed  Google Scholar 

  24. Wendler O, Tscholl D, Huang Q, Schäfers H-J. Free flow capacity of skeletonized versus pedicled internal thoracic artery grafts in coronary artery bypass grafts. Eur J Cardiothorac Surg. 1999;15:247–50.

    Article  CAS  PubMed  Google Scholar 

  25. Dohi M, Doi K, Okawa Y, Yaku H. Upgrading redo coronary artery bypass graft by recycling in situ arterial graft. Ann Thorac Surg (in press).

  26. Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularization on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet. 2001;358:870–5.

    Article  CAS  PubMed  Google Scholar 

  27. Min HK, Lee YT, Kim WS, Yang JH, Sung K, Jun TG, Park PW. Complete revascularization using a patent left internal thoracic artery and variable arterial grafts in multivessel coronary reoperation. Heart Surg Forum. 2009;12:E244–9.

    Article  PubMed  Google Scholar 

  28. Glineur D, Noirhomme P, Poncelet A, Hanet C, Astarci P, Verhelst R, Etienne PY, El Khoury G. Gatroepiploic artery minimally invasive grafting in reoperative patients with patent mammaries. Ann Thorac Surg. 2005;79:1606–9.

    Article  PubMed  Google Scholar 

  29. Tavilla G, Bruggemans EF. Avoiding sternotomy in repeat coronary artery bypass grafting: feasibility, safety, and mid-term outcome of the transabdominal off-pump technique using the right gastroepiploic artery. J Thorac Cardiovasc Surg. 2012;144:124–9.

    Article  PubMed  Google Scholar 

  30. Puskas JD, Thourani VH, Kilgo P, Cooper W, Vassiliades T, Vega JD, Morris C, Chen E, Schmotzer BJ, Guyton RA, Lattouf OM. Off-pump coronary artery bypass disproportionately benefit high-risk patients. Ann Thorac Surg. 2009;88:1142.

    Article  PubMed  Google Scholar 

  31. Sedrakyan A, Wu AW, Parashar A, Bass EB, Treasure T. Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery bypass grafting: a meta-analysis of systematically reviewed trials. Stroke. 2006;37:2759–69.

    Article  PubMed  Google Scholar 

  32. Doi K, Yaku H. Importance of cerebral artery risk evaluation before off-pump coronary artery bypass grafting to avoid perioperative stroke. Eur J Cardiothorac Surg. 2010;38:568–72.

    Article  PubMed  Google Scholar 

  33. Vohra HA, Bahrami T, Farid S, Mafi A, Dreyfus G, Amrani M, Gaer JAR. Propensity score analysis of early and late outcome after redo off-pump and on-pump coronary artery bypass grafting. Eur J Cardiothorac Surg. 2008;33:209–14.

    Article  PubMed  Google Scholar 

  34. Tugtekin SM, Alexiou K, Kappert U, Esche H, Joskowiak D, Knaut M, Matschke K. Coronary reoperation with and without cardiopulmonary bypass. Clin Res Cardiol. 2006;95:93–8.

    Article  CAS  PubMed  Google Scholar 

  35. Morris CD, Puskas JD, Pusca SV, Lattouf OM, Cooper WA, Vassiliades TA, Chen EP, Thourani VH, Kilgo PD, Guyton RA. Outcomes after off-pump reoperative coronary artery bypass grafting. Innovations (Phila). 2007;2:29–32.

    Article  Google Scholar 

  36. Kara I, Cakalagaoglu C, Ay Y, Al Salehi S, Yanartas M, Anasiz H, Koksal C. Reoperative coronary artery bypass surgery: the role of on-pump and off-pump techniques on factors affecting hospital mortality and morbidity. Ann Thorac Cardiovasc Surg. 2013;19:435–40.

    Article  PubMed  Google Scholar 

  37. Dohi M, Miyata H, Doi K, Okawa K, Motomura N, Takamoto S, Yaku H. The off-pump technique in redo coronary artery bypass grafting reduces mortality and major morbidities: propensity score analysis of data from the Japan Cardiovascular Surgery Database. Eur J Cardiothorac Surg. [Epub ahead of print].

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All the authors have declared no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Hitoshi Yaku & Kiyoshi Doi

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  1. Hitoshi Yaku
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  2. Kiyoshi Doi
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Correspondence to Hitoshi Yaku.

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This review was submitted at the invitation of the editorial committee.

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Yaku, H., Doi, K. Redo coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 62, 453–460 (2014). https://doi.org/10.1007/s11748-014-0426-6

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