ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2002 April;43(2):143-6

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Use of midcab procedure for redo coronary artery bypass

Pascucci S., Günkel L., Zietak T., Eschenbruch E., Tollenaere P. J.

From the Department of Cardiovascular Surgery Herz-Zentrum Bad Krozingen Bad Krozingen, Germany

Background. Reoperative cor­o­nary ­artery ­bypass graft­ing (CABG) pro­ce­dures are grow­ing in impor­tance due to the increas­ing num­ber of ­patients requir­ing ­another ­bypass oper­a­tion. Conventional ­redo-pro­ce­dures are asso­ciat­ed ­with an ­increased mor­tal­ity and mor­bid­ity. To ­reduce ­risk, min­i­mal­ly inva­sive ­direct cor­o­nary ­artery ­bypass (MID­CAB) ­using the ­left inter­nal mam­mary ­artery (­LIMA) to the ­left ante­ri­or descend­ing ­branch (LAD) may be pref­er­able, ­when indi­cat­ed, in select­ed ­patients. We ­report a ­series of ­patients who under­went ­this pro­ce­dure for ­redo-­CABG in our cen­ter.
Methods. Since April 1997, 20 ­male ­patients who had under­gone ­prior ­CABG ­using con­ven­tion­al pro­ce­dure, ­were reop­er­at­ed ­using the ­LIMA to LAD ­through a lat­er­al min­i­thor­a­cot­o­my on the beat­ing ­heart. Nineteen ­patients pre­sent­ed for a ­redo-­CABG; one ­patient ­required a sec­ond-­time ­redo-­CABG. Two ­patients ­required con­com­i­tant ­PTCA of a sec­ond ves­sel as ­hybrid pro­ce­dure. We ­reviewed ­these ­redo cas­es and stud­ied ­their sur­gi­cal ­results for mor­tal­ity, mor­bid­ity, oper­a­tion ­time, and hos­pi­tal ­stay.
Results. Mean oper­a­tion ­time was 139 min (90-180). Four ­patients ­were extu­bat­ed direct­ly post­op­er­a­tive­ly; the oth­ers had a ­short peri­od of ven­til­a­to­ry sup­port. There was no myo­car­dial infarc­tion, no ­deaths or ­need of inotrop­ic sup­port post­op­er­a­tive­ly. No ­patient ­required re-explo­ra­tion for bleed­ing. All ­patients ­could be mobi­lized and dis­charged ear­ly. At ­present, all ­patients are liv­ing and clas­si­fied as CCS ­class I or II.
Conclusions. Our ­results indi­cate ­that MID­CAB ­using IMA ­grafts for reop­er­a­tion is a ­safe pro­ce­dure ­with low ­risk for mor­bid­ity and mor­tal­ity. This sur­gi­cal tech­nique is a use­ful alter­na­tive to con­ven­tion­al ­redo ­CABG in select­ed ­patients ­when com­plete revas­cu­lar­isa­tion is not indi­cat­ed.