The Journal of thoracic and cardiovascular surgery · 2025
Redo coronary artery bypass grafting in patients with patent bilateral internal thoracic artery grafts: Exceptions to a lifetime warranty.
СтатьяНазвание и аннотация: Перевод в очереди
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Alshneikat Mahmoud, Ramsingh Richard, Awad Ahmed K, Houghtaling Penny L, Unai Shinya G, Koprivanac Marijan J, Tong Michael Z, Elgharably Haytham J, McCurry Kenneth R, Vargo Patrick R, Soltesz Edward G, Smedira Nicholas G, Pettersson Gösta B, Roselli Eric E, Gillinov A Marc, Svensson Lars G, Blackstone Eugene H, Bakaeen Faisal G
Аннотация
OBJECTIVE: To undertake an in-depth review of patients undergoing redo coronary artery bypass grafting (CABG) despite patent bilateral internal thoracic artery (BITA) grafts.
METHODS: From January 1980 to July 2020, 91 of 8108 patients (1.1%) who underwent isolated redo CABG had patent BITAs. Mean age was 62 ± 8.7 years; 81 (89%) were male. Mean age at previous CABG was 52 ± 9.4 years, with reoperation occurring after a median of 10 years. Indications for reoperation, surgical strategies, and outcomes were analyzed.
RESULTS: All patients had ischemic symptoms, most commonly unstable angina (65 [71%]). Anatomic drivers of reoperation included progression of native coronary atherosclerosis (63 [69%]), non-BITA graft failure (63 [69%]), and patent but diseased, atretic, or technically compromised internal thoracic artery grafts (ITAs) (34 [37%]; left: 12, right: 18, bilateral: 4). The left anterior descending artery (LAD) was previously bypassed with an ITA in 78 (86%). At reoperation, conduits used included saphenous vein (75 [82%]), radial artery (39 [43%]), and gastroepiploic artery (8 [8.8%]). Coronary targets included circumflex (58 [64%]), right coronary (54 [59%]), LAD (36 [40%]), and diagonal (28 [31%]) arteries. Operative mortality and median survival were 3.3% and 12 years, respectively.
CONCLUSIONS: Patients with patent BITAs represent a small subset of redo CABG cases, with native coronary disease progression and non-ITA graft failure being the most common reoperation indications. Most patients undergo multivessel grafting, with less than one half needing or requiring a bypass to the LAD. Outcomes are good at centers with experienced surgeons.
METHODS: From January 1980 to July 2020, 91 of 8108 patients (1.1%) who underwent isolated redo CABG had patent BITAs. Mean age was 62 ± 8.7 years; 81 (89%) were male. Mean age at previous CABG was 52 ± 9.4 years, with reoperation occurring after a median of 10 years. Indications for reoperation, surgical strategies, and outcomes were analyzed.
RESULTS: All patients had ischemic symptoms, most commonly unstable angina (65 [71%]). Anatomic drivers of reoperation included progression of native coronary atherosclerosis (63 [69%]), non-BITA graft failure (63 [69%]), and patent but diseased, atretic, or technically compromised internal thoracic artery grafts (ITAs) (34 [37%]; left: 12, right: 18, bilateral: 4). The left anterior descending artery (LAD) was previously bypassed with an ITA in 78 (86%). At reoperation, conduits used included saphenous vein (75 [82%]), radial artery (39 [43%]), and gastroepiploic artery (8 [8.8%]). Coronary targets included circumflex (58 [64%]), right coronary (54 [59%]), LAD (36 [40%]), and diagonal (28 [31%]) arteries. Operative mortality and median survival were 3.3% and 12 years, respectively.
CONCLUSIONS: Patients with patent BITAs represent a small subset of redo CABG cases, with native coronary disease progression and non-ITA graft failure being the most common reoperation indications. Most patients undergo multivessel grafting, with less than one half needing or requiring a bypass to the LAD. Outcomes are good at centers with experienced surgeons.