Aorta-sparing total arterial redo-CABG using a recycled patent LIMA: a consecutive 24-patient series with midterm clinical and computed tomographic outcomes.

BACKGROUND

Redo coronary artery bypass grafting (Redo-CABG) poses significant challenges due to complex coronary anatomy and limited conduit availability. In patients with a previously patent left internal mammary artery (LIMA), reusing it as an inflow source for total arterial revascularization (TAR) may offer a durable, stroke-sparing strategy. This study evaluated the safety and midterm outcomes of reusing a patent LIMA as an inflow source in Redo-CABG.

METHODS

This retrospective case series included 24 patients who underwent Redo-CABG at Faghihi and Dena Hospitals (Shiraz University of Medical Sciences) between March 2015 and October 2023. Consecutive patients were included to minimize selection bias. All patients had a patent LIMA confirmed by angiography or computed tomography angiography (CTA). Arterial grafts (right internal mammary and/or radial artery) were anastomosed to the patent LIMA to achieve complete TAR. Outcomes included perioperative complications, graft patency on CTA, and midterm major adverse cardiac or cerebrovascular events (MACCE).

RESULTS

All patients achieved complete TAR with no hospital or 30-day mortality. One patient required reoperation for bleeding. Mean postoperative ejection fraction was 44.5 ± 4.6%, and mean ICU stay was 3.1 ± 0.9 days. Early postoperative CT angiography (at 3 months) and midterm follow-up imaging (median 3.5 years; completed in a subgroup of 12 patients) demonstrated complete graft patency in all evaluated conduits, with no recorded MACCE.

CONCLUSIONS

Reusing a patent LIMA as an inflow source for total arterial grafting in Redo-CABG appears to be a feasible and safe alternative for high-risk patients with limited conduit options. This approach minimizes extensive aortic manipulation, potentially offering a theoretical advantage in minimizing neurological risks. However, the retrospective, single-center design and small sample size preclude definitive conclusions regarding superiority, warranting further comparative evaluation in larger multicenter studies.