Clinical Analysis of Redo Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Gang , CHEN Yu , LING Yunpeng , CHEN Shenglong , WAN Feng.

1. Department of Cardiovascular Surgery， People’s Hospital of Peking University， Beijing 100044， P. R . China;;
2. Department of Cardiovascular Surgery， Third Hospital of Peking　University， Beijing 100083， P. R. China;

Corresponding author：

Keywords：

Coronary artery disease; 　Redo coronary artery bypass grafting; 　Off-pump coronary artery bypass grafting

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Abstract：　Objective?To summarize our experience of redo coronary artery bypass grafting（CABG） and explore appropriate redo CABG strategy for Chinese patients.　Methods　We retrospectively analyzed clinical data of 27 patients who underwent redo CABG in People’s Hospital of Peking University from January 2000 to January 2010. There were 15 male patients and 12 female patients with their age of 41-84 （63±8） years. The mean time between the first CABG and the redo CABG was 45 （4-168） months. Preoperatively all the patients had unstable angina pectoris. Twenty-one patients were in New York Heart Association （NYHA） functional classⅠ-Ⅱ， and 6 patients were in NYHA functional classⅢ-Ⅳ.　Preoperatively， their left ventricular end-diastolic dimension （LVEDD） was 41-69 （51.0±0.7） mm， and their left ventricular　ejection fraction （LVEF） was 32%-78% （58%±12%）. At the time of redo CABG for the 27 patients， there were 6 new coronary artery lesions， 7 left internal mammary artery （LIMA） lesions， 3 radial artery lesions （including 1 proximal anastomosis lesion alone） and 49 saphenous vein graft （SVG） lesions （including 3 proximal lesions alone and 3 distal lesions　alone）.?Results?The surgical approach of redo CABG included median sternotomy in 18 patients， left lateral thoracotomy　in 8 patients， upper midline abdomen and subxiphoid incision in 1 patient. Off-pump coronary artery bypass grafting （OPCAB）　surgery was performed in 25 patients， but intra-operatively 2 patients underwent conversion to CABG under cardiopulmonary　bypass. A total of 65 distal anastomoses and 41 proximal anastomoses were performed during redo CABG. A total of 10 LIMA， 3 right internal mammary artery (RIMA)， 16 left radial artery， 2 right radial artery and 17 SVG were used in redo CABG . There were 1-4 （2.4±0.8） distal anastomoses for each patients. The operation time was 170-530 （304±86）min. Postoperative transfusion was 0-10 （4.3±3.5） U packed red blood cells and 0-1 600 (685±549) ml fresh frozen plasma for each patient. Postoperative mechanical ventilation time was 6-156 （24±32） h and postoperative hospital stay was 7-35 （14±6） d . There was no in-hospital death. All the patients were discharged without any angina symptoms. A total of 26 patients were followed up and 1 patient was lost with the mean follow-up time of 80 （13-133） months. During follow-up， 16 patients were alive without angina symptoms， 4 patients died， and 6 patients had recurrent angina symptoms or heart failure.　Conclusions　OPCAB is an effective surgical strategy of redo CABG， but cardiopulmonary bypass should also be prepared. Arterial graft should be use as long as possible in redo CABG and the surgical strategy should be individualized.

Citation： LIU Gang,CHEN Yu,LING Yunpeng,CHEN Shenglong,WAN Feng.. Clinical Analysis of Redo Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(6): 602-605. doi: Copy

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12.	孙寒松，吴松，胡盛寿，等. 非体外循环和体外循环冠状动脉旁路移植术在二次冠状动脉旁路移植术中的应用，中国胸心血管外科临床杂志， 2007， 14 （6）：404-406.
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1. 　Philippe K， William W， Nicolas D， et al. Guidelines on myocardial　revascularization. Eur J Cardiothoracic Surg，2010，38 （S1）：　S1-S52.
2. 　Head SJ， Holmes DR Jr， Mack MJ， et al. Risk profile and 3-year outcomes from the SYNTAX percutaneous coronary intervention and coronary artery bypass grafting nested registries. JACC Cardiovasc Interv， 2012， 5 （6）：618-625.
3. 　Hiroyuki N， Masataka M， Mitsuhiro Y， et al. Safe approach for redo coronary artery bypass grafting ? preventing injury to the patent graft to the left anterior descending artery. Ann Thorac Surg，2010，16 （4）：253-258.
4. 　刘刚，董穗欣，解基严. 冠状动脉旁路移植术后机械通气时间延长的危险因素分析. 北京医学， 2008， 30 （10）：592-595.
5. 　Pallav JS， Manoj D， Ian G， et al. Factors affecting patency of　internal thoracic artery graft： clinical and angiographic study in 1434 symptomatic patients operated between 1982 and 2004. Eur J　Cardiothorac Surg，2004， 26 （1）：118-124.
6. 　Joseph FS， Eugene HB， Marc G. Influence of patient characteristics and arterial grafts on freedom from coronary reoperation. J Thorac Cardiovasc Surg ，2006，131 （1）： 90-98.
7. 　Thomas VB， James AV， Christos MR， et al. Functional assessment of disease-free saphenous vein grafts at redo coronary artery bypass grafting. Ann Thorac Surg， 2000， 69 （4）：1183.
8. 　Pankaj S， Lisa F， Rohan VD， et al. Value of multislice CT scan in redo cardiac surgery with previous lita graft. Heart Lung Circulation，2009，18 （2）：133-162.
9. 　Strecker T， Kondruweit M， Weyand M， et al. 128-slice CT in the assessment of saphenous vein grafts at redo coronary artery bypass grafting. J Card Surg， 2009，24 （4）：464-465.
10. 　Sreekumar S， Joseph FS， Penny LH， et al. Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending. Ann Thorac Surg，2009，87 （5）：1392-1400.
11. 　Spiliotopoulos K， Maganti M， Brister S， et al. Changing pattern of reoperative coronary artery bypass grafting： a 20-year study. Ann Thorac Surg，2011 ，92 （1）：40-46.
12. 　孙寒松，吴松，胡盛寿，等. 非体外循环和体外循环冠状动脉旁路移植术在二次冠状动脉旁路移植术中的应用，中国胸心血管外科临床杂志， 2007， 14 （6）：404-406.
13. 　Hunaid AV， Toufan B， Shakil F， et al. Propensity score analysis of early and late outcome after redo off-pump and on-pump coronary artery bypass grafting. Eur J Cardiothorac Surg，2008，33 （2）：209-214.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Analysis of Redo Coronary Artery Bypass Grafting

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