Clinical Application of Re-do Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Xin , XU Ming , SHI Kaihu

Department of Thoracic and Cardiovascular Surgery, Nanjing Cardiovascular Disease Research Institute, Nanjing First Hospital Affiliated to Nanjing Medical University , Nanjing ,210006, P.R.China. E-mail: stevecx@sina.com;

Corresponding author：

Keywords：

Coronary atherosclerotic heart disease; Re-coronary artery bypass grafting; Graft

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Objective To summarize and analyze the clinical experience and surgical results of re-do coronary artery bypass grafting (Re-CABG) for reconvert coronary artery disease. Methods Eighteen patients who underwent Re-CABG in this hospital between June 2001 and December 2006 were analyzed. There were 15 males and 3 females aged from 65 to 78 years old. Seven patients were in class III angina(CCS) and 11 patients were in class IV. Coronary artery angiography showed stenosis or occlusion of great saphenous vein grafts in 16 patients, occlusion of left internal mammary artery(LIMA) grafts in 2 patients and new significant stenosis of the native coronary artery in 6 patients. All Re-CABG were done through re-sternotomy. Fifteen patients underwent cardiopulmonary bypass (CPB for their Re-CABG and 3 patients underwent off-pump Re-CABG. The concomitant procedures included left ventricular aneurysmectomy in 1 patient, mitral valve repair in 3 patients, combined aortic and mitral valve replacement and carotid endarterectomy in 1 patient. Bilateral IMA were used in 4 patients, LIMA in 12 patients, radial artery in 3 patients, and the rest of the grafts consisted of great and lesser saphenous vein. Results In on-pump Re-CABG, the aortic cross clamp time was 57±26min (range 45 to 112 min), the CPB time was 78±24min (range 66 to 140 min).The mean number of distal anastomosis per patient was 3.11(range 1 to 5). Intraoperative flow study of the grafts by Medi-Stim Butterfly showed a mean flow rate of 27.0±12.5 ml/min with pulsatility index( PI)less than 4.2. Intra-aortic balloon pump (IABP) was used in 1 patient who underwent concomitant aortic and mitral valve replacement and carotid endarterectomy. Post-operatively this patient developed renal failure and expired 6 days later. There was no residual angina and peri-operative myocardial infarction in the remain 17 patients.The post-operatively mechanical ventilation time varied from 5 to 15 hours, chest drainage varied from 290 to 1 040ml. Seventeen patients were discharged uneventfully. Follow-up from 6 months to 4.5years in 17 patients showed no evidence of recurrent angina. Postoperative coronary artery angiography in 4 patients showed patent grafts. Conclusion Re-CABG can be performed as safely and effectively as primary CABG in spite of the fact that it is more demanding. Selecting the proper target vessels, satisfactory blood flow of grafts, complete revascularization and proper peri-operative management are all key factors to a successful Re-CABG.

Citation： CHEN Xin,XU Ming,SHI Kaihu,JIANG Yingshuo,WANG Liming,QIU Zhibing,XIAO Liqiong,ZHAO Haipeng,LIU Peisheng,WANG Rui,ZHENG Lin. Clinical Application of Re-do Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2007, 14(6): 407-. doi: Copy

1.	Di Mauro M, Iac｀o AL, Contini M, et al. Reoperative coronary artery bypass grafting: analysis of early and late outcomes. Ann Thorac Surg, 2005,79(1):81-87.
2.	Lawrie GM, Morris GC Jr, Earle N. Long-term results of coronary bypass surgery. Analysis of 1698 patients followed 15 to 20 years. Ann Surg,1991,213(5):377-385.
3.	Calafiore AM, Di Giammarco G, Teodori G, et al. Late results of first myocardial revascularization in multiple vessel disease: single versus bilateral internal mammary artery with or without saphenous vein grafts. Eur J Cardiothorac Surg, 2004,26(3):542-548.
4.	Hilker M, Buerke M, Lehr HA, et al. Bypass graft disease: analysis of proliferative activity in human aorto-coronary bypass grafts. Heart Surg Forum, 2002, 5(Suppl 4):S331-341.
5.	Silva JA, White CJ, Collins TJ, et al. Morphologic comparison of atherosclerotic lesions in native coronary arteries and saphenous vein graphs with intracoronary angioscopy in patients with unstable angina. Am Heart J, 1998,136(1):156-163.
6.	van Eck FM, Noyez L, Verheugt FW, et al. Changing profile of patients undergoing redo-coronary artery surgery. Eur J Cardiothorac Surg, 2002, 21(2):205-211.
7.	de Feyter PJ. The fatal attraction of saphenous venous bypass grafts. Eur Heart J, 2000,21(9):697-698.
8.	Bilfinger TV, Vosswinkel JA, Rialas CM, et al. Functional assessment of disease-free saphenous vein grafts at redo coronary artery bypass grafting. Ann Thorac Surg, 2000, 69(4):1183-1187.
9.	Baklanov DV, Peters KG, Seidel AL, et al. Neovascularization in intimal hyperplasia is associated with vein graft failure after coronary artery bypass surgery. Vasc Med, 2003,8(3):163-167.
10.	Loop FD, Lytle BW, Cosgrove DM, et al. Reoperation for coronary atherosclerosis. Changing practice in 2509 consecutive patients. Ann Surg,1990,212(3):378-385.
11.	Lytle BW, Loop FD, Taylor PC, et al. Vein graft disease: the clinical impact of stenoses in saphenous vein bypass grafts to coronary arteries. J Thorac Cardiovasc Surg, 1992,103(5):831-840.
12.	Ashraf O. Redo coronary bypass grafting: role of arterial grafts and time interval. J Thorac Cardiovasc Surg, 2006,132(1):209-210.
13.	Machiraju VR. How to avoid problems in redo coronary artery bypass. J Card Surg, 2002,17(1):20-25.
14.	Rankin JS, Tuttle? RH, Wechsler AS, et al.Techniques and benefits of multiple internal mammary artery bypass at 20 years of follow-up. Ann Thorac Surg, 2007, 83(3):1008-1015.
15.	Lytle BW, Loop FD, Taylor PC, et al. The effect of coronary reoperation on the survival of patients with stenoses in saphenous vein bypass grafts to coronary arteries. J Thorac Cardiovasc Surg, 1993,105(4):605-612.

1. 　Di Mauro M, Iac｀o AL, Contini M, et al. Reoperative coronary artery bypass grafting: analysis of early and late outcomes. Ann Thorac Surg, 2005,79(1):81-87.
2. 　Lawrie GM, Morris GC Jr, Earle N. Long-term results of coronary bypass surgery. Analysis of 1698 patients followed 15 to 20 years. Ann Surg,1991,213(5):377-385.
3. 　Calafiore AM, Di Giammarco G, Teodori G, et al. Late results of first myocardial revascularization in multiple vessel disease: single versus bilateral internal mammary artery with or without saphenous vein grafts. Eur J Cardiothorac Surg, 2004,26(3):542-548.
4. 　Hilker M, Buerke M, Lehr HA, et al. Bypass graft disease: analysis of proliferative activity in human aorto-coronary bypass grafts. Heart Surg Forum, 2002, 5(Suppl 4):S331-341.
5. 　Silva JA, White CJ, Collins TJ, et al. Morphologic comparison of atherosclerotic lesions in native coronary arteries and saphenous vein graphs with intracoronary angioscopy in patients with unstable angina. Am Heart J, 1998,136(1):156-163.
6. 　van Eck FM, Noyez L, Verheugt FW, et al. Changing profile of patients undergoing redo-coronary artery surgery. Eur J Cardiothorac Surg, 2002, 21(2):205-211.
7. 　de Feyter PJ. The fatal attraction of saphenous venous bypass grafts. Eur Heart J, 2000,21(9):697-698.
8. 　Bilfinger TV, Vosswinkel JA, Rialas CM, et al. Functional assessment of disease-free saphenous vein grafts at redo coronary artery bypass grafting. Ann Thorac Surg, 2000, 69(4):1183-1187.
9. 　Baklanov DV, Peters KG, Seidel AL, et al. Neovascularization in intimal hyperplasia is associated with vein graft failure after coronary artery bypass surgery. Vasc Med, 2003,8(3):163-167.
10. 　Loop FD, Lytle BW, Cosgrove DM, et al. Reoperation for coronary atherosclerosis. Changing practice in 2509 consecutive patients. Ann Surg,1990,212(3):378-385.
11. 　Lytle BW, Loop FD, Taylor PC, et al. Vein graft disease: the clinical impact of stenoses in saphenous vein bypass grafts to coronary arteries. J Thorac Cardiovasc Surg, 1992,103(5):831-840.
12. 　Ashraf O. Redo coronary bypass grafting: role of arterial grafts and time interval. J Thorac Cardiovasc Surg, 2006,132(1):209-210.
13. 　Machiraju VR. How to avoid problems in redo coronary artery bypass. J Card Surg, 2002,17(1):20-25.
14. 　Rankin JS, Tuttle? RH, Wechsler AS, et al.Techniques and benefits of multiple internal mammary artery bypass at 20 years of follow-up. Ann Thorac Surg, 2007, 83(3):1008-1015.
15. 　Lytle BW, Loop FD, Taylor PC, et al. The effect of coronary reoperation on the survival of patients with stenoses in saphenous vein bypass grafts to coronary arteries. J Thorac Cardiovasc Surg, 1993,105(4):605-612.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Application of Re-do Coronary Artery Bypass Grafting

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