Complete revascularization using a patent left internal thoracic artery and variable arterial grafts in multivessel coronary reoperation

Background: Arterial grafting and complete revascularization are important requirements of coronary surgery to achieve optimum long-term results. In cases involving coronary artery bypass grafting reoperation (redo-CABG), it is sometimes difficult to satisfy these requirements because of the limited availability of grafts. In this study, we constructed composite and sequential grafting with a minimal number of new arterial grafts and a patent left internal thoracic artery (LITA), which sometimes is encountered in preoperative angiography, and we analyzed the results of redo-CABG. Methods: Between January 2005 and October 2008, 29 patients underwent redo-CABG. Ten patients who had a patent LITA graft in situ were reviewed retrospectively. We performed conventional CABG in 8 patients and on-pump beating-heart CABG in 2 patients. The new arterial grafts for the composite grafts included 7 LITAs and 3 radial arteries. The types of composite grafts included 7 Y grafts, 1 K graft, 1 X graft, and 1 double-Y graft. Overall, we performed 28 distal anastomoses (mean per patient, 2.8 ± 0.7), of which 18 anastomoses were supplied from a patent LITA (mean, 1.8 ± 0.4). Results: No hospital deaths occurred, and perioperative complications included injury to a LITA, low cardiac output, delirium, and postoperative bleeding in 1 patient each. The mean duration of follow-up was 23.6 ± 16.8 months (range, 2-46 months). There was 1 late death and no recurrent angina during the follow-up period. Follow-up coronary images obtained for 7 patients showed that all of the anastomoses were patent. Conclusion: Composite and sequential grafting with new arterial grafts and a patent LITA is a safe and effective alternative in patients with multivessel disease undergoing redo-CABG.