Redo Cardiac Surgery after Previous CABG with Functioning Internal Thoracic Artery Grafts

(Department of Cardiovascular Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan, and Department of Cardiovascular Surgery, University of Miyazaki*, Miyazaki, Japan)

Kazushi Kojima Eisaku Nakamura Katsuhiko Niina
George Endo Kunihide Nakamura*
We clinically reviewed 4 cases of redo cardiac surgery after previous CABG with functioning internal thoracic artery grafts. The patients consisted of 1 man and 3 women(76.8±8.3 years old). Internal thoracic artery(ITA)grafts were used in all patients. Furthermore, 2 mitral valve replacements, 1 aortic valve replacement and 1 replacement of the ascending aorta were performed as redo cardiac surgery. The heart was approached via a anterolateral right thoracotomy in 3 cases. Femoral artery cannulation was used for cardiopulmonary bypass, and the right superior pulmonary vein was exposed to vent the left ventricle in all patients. The functioning ITA grafts were not dissected and were clamped in all cases of the 4 patients, 2 underwent cardioplegic arrest under moderate hypothermia. We could not achieve cardioplegic arrest in 1 patient, and therefore we also performed deep hypothermic fibrillatory arrest. Another patient underwent deep hypothermic circulatory arrest. Serum CK-MB values were elevated in all cases(111.7±89.0IU/l ). However, these elevations did not correlate with intraoperative arrest duration or type of operative procedure performed. Operative mortality was 0%, and all patients were discharged with out any evidence of sequelae. Hypothermic fibrillatory arrest had an effective additional cardioprotective effect for incomplete cardioplegia in these 4 cases. Functioning ITA grafting was not necessary in dissection and clamping for cardioprotection. An anterolateral right thoracotomy provided a safe approach to the heart, avoiding functioning ITA graft injury.
  Jpn. J. Cardiovasc. Surg. 40:188-192(2011)

Keywords:redo surgery, cardioprotection, internal thoracic artery