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. 2011;4(4):299-305.
doi: 10.3400/avd.oa.11.00039. Epub 2011 Nov 15.

Cardiac and Aortic Reoperation for Patients with Functional Grafts after CABG

Satoshi Yamashiro  1 , Kuniyoshi Yukiko, Yuya Kise, Ryoko Arakaki
Affiliations

Cardiac and Aortic Reoperation for Patients with Functional Grafts after CABG

Satoshi Yamashiro et al. Ann Vasc Dis. 2011.

Abstract

Objective: Late cardiac and aortic reoperation after CABG is indispensable for patients with atherosclerotic disease, but reoperations are still associated with high morbidity rates.

Patients and methods: Between January 2002 and December 2010, 459 patients underwent coronary artery bypass grafting. Six patients (males; mean age, 65.0 ± 5.7 years) with previous arterial bypass grafts (mean, 2.8 ± 1.2 per patient) required reoperation for cardiac and aortic disease (3, valvular disease; 3, acute type I aortic dissection) during long-term follow-up. The mean interval between the initial operation and reoperation was 5.4 ± 2.0 years. Grafts visualized by preoperative enhanced computed tomography were harvested as pedicles and clamped for myocardial protection. The total arch or ascending aorta was replaced in three patients. The aortic valve was replaced in two patients, and the aortic and mitral valves were replaced in one.

Results: Durations for surgery, total cardiopulmonary bypass, and cardiac ischemia were 611.5 ± 172.6, 223.2 ± 88.4, and 133.4 ± 58.0 minutes, respectively. Perioperative myocardial infarction did not develop, and all patients recovered uneventfully with no neurological deficits.

Conclusion: Bypass grafts should be preoperatively visualized and carefully exposed. Cardiac damage must be avoided during reoperation after coronary artery bypass grafting.

Keywords: aortic dissection; cardiac reoperation; coronary artery bypass grafting; internal thoracic artery.

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Figures

Fig. 1
Fig. 1
Computed tomography (CT) images and operative details of Case 5. A. Preoperative enhanced chest CT shows left internal thoracic artery (LITA) tightly attached to chest wall. B. Pedicled LITA (arrow) and right gastroepiploic artery (RGEA) (dotted arrow) are safely exposed and clamped during cardiac arrest.
Fig. 2
Fig. 2
Computed tomography (CT) image of Case 6. A. Preoperative enhanced CT shows right internal thoracic artery (RITA) (arrow), left internal thoracic artery (LITA) (dotted arrow) and right gastroepiploic artery (RGEA) (arrowhead). B. RITA has crossed over front of ascending aorta (arrow).
Fig. 3
Fig. 3
Post-operative computed tomography (CT) image of Case 6. Post-operative three-dimensional CT shows well-preserved bypass grafts including translocated right gastroepiploic artery (RGEA)-LAD (black arrow).
See this image and copyright information in PMC

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