Skip to main content
SpringerLink
Log in

Redo coronary artery bypass grafting

  • Review Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

Redo coronary artery bypass grafting (CABG) can be one of the most technically challenging operations in cardiac surgery. The coronary disease is more advanced, and the coronary targets may be suboptimal. In addition, the patients are typically older and sicker compared to those undergoing primary CABG.

Methods

A literature review focused on the epidemiology, operative techniques, and outcomes associated with redo CABG.

Results

The frequency of redo CABG relative to total CABG procedures has been decreasing over time. From 2000 to 2009, redo CABG decreased from 6.0 to 3.4% of all CABG procedures reported to the STS Adult Cardiac Surgery Database (STS ACSD) and currently stands at 2%. Risks associated with reoperations include diabetes and renal dialysis. Perioperative mortality for redo CABG is reported to be as high as three times that of primary CABG, but this risk is reduced with experience. Careful preoperative planning including quality imaging and precise surgical technique coupled with meticulous myocardial protection contributes to good outcomes. Experience is important in optimizing outcomes.

Conclusions

Redo CABG is a complicated operation and surgical experience, and appropriate perioperative strategies are essential for achieving optimal outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fosbol EL, Zhao Y, Shahian DM, Grover FL, Edwards FH, Peterson ED. Repeat coronary revascularization after coronary artery bypass surgery in older adults: the Society of Thoracic Surgeons' national experience, 1991-2007. Circulation. 2013;127:1656–63.

    Article  PubMed  Google Scholar 

  2. Sabik JF 3rd, Blackstone EH, Gillinov AM, Smedira NG, Lytle BW. Occurrence and risk factors for reintervention after coronary artery bypass grafting. Circulation. 2006;114:I454–60.

    Article  PubMed  Google Scholar 

  3. Ghanta RK, Kaneko T, Gammie JS, Sheng S, Aranki SF. Evolving trends of reoperative coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg. 2013;145:364–72.

    Article  PubMed  Google Scholar 

  4. Yaku H, Doi K. Redo coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2014;62:453–60.

    Google Scholar 

  5. Kolh P, Wijns W, Danchin N, et al. Guidelines on myocardial revascularization. Eur J Cardiothorac Surg. 2010;38:S1–S52.

    Article  Google Scholar 

  6. Subramanian S, Sabik JF 3rd, Houghtaling PL, Nowicki ER, Blackstone EH, Lytle BW. Decision-making for patients with patent left internal thoracic artery grafts to left anterior descending. Ann Thorac Surg. 2009;87:1392–8.

    Article  PubMed  Google Scholar 

  7. Kamdar AR, Meadows TA, Roselli EE, et al. Multidetector computed tomographic angiography in planning of reoperative cardiothoracic surgery. Ann Thorac Surg. 2008;85:1239–45.

    Article  PubMed  Google Scholar 

  8. Machiraju VR. How to avoid problems in redo coronary artery bypass surgery. J Card Surg. 2004;19:284–90.

    Article  CAS  PubMed  Google Scholar 

  9. Gillinov AM, Casselman FP, Lytle BW, et al. Injury to a patent left internal thoracic artery graft at coronary reoperation. Ann Thorac Surg. 1999;67:382–6.

    Article  CAS  PubMed  Google Scholar 

  10. Loop FD, Lytle BW, Gill CC, Golding LA, Cosgrove DM, Taylor PC. Trends in selection and results of coronary artery reoperations. Ann Thorac Surg. 1983;36:380–8.

    Article  CAS  PubMed  Google Scholar 

  11. Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery. Ann Thorac Surg. 2009;88:S2–22.

  12. Sabik JF 3rd, Blackstone EH, Houghtaling PL, Walts PA, Lytle BW. Is reoperation still a risk factor in coronary artery bypass surgery? Ann Thorac Surg. 2005;80:1719–27.

    Article  PubMed  Google Scholar 

  13. Roselli EE, Pettersson GB, Blackstone EH, et al. Adverse events during reoperative cardiac surgery: frequency, characterization, and rescue. J Thorac Cardiovasc Surg. 2008;135:316–23.

    Article  PubMed  Google Scholar 

  14. Sabik JF 3rd, Raza S, Blackstone EH, Houghtaling PL, Lytle BW. Value of internal thoracic artery grafting to the left anterior descending coronary artery at coronary reoperation. J Am Coll Cardiol. 2013;61:302–10.

    Article  PubMed  Google Scholar 

  15. Loop FD, Lytle BW, Cosgrove DM, et al. Reoperation for coronary atherosclerosis. Changing practice in 2509 consecutive patients. Ann Surg. 1990;212:378–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Svensson LG, Mumtaz MA, Blackstone EH, et al. Does use of a right internal thoracic artery increase deep wound infection and risk after previous use of a left internal thoracic artery? J Thorac Cardiovasc Surg. 2006;131:609–13.

    Article  PubMed  Google Scholar 

  17. Zacharias A, Schwann TA, Riordan CJ, et al. Late outcomes after radial artery versus saphenous vein grafting during reoperative coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2010;139:1511–8.

    Article  PubMed  Google Scholar 

  18. Aldea GS, Bakaeen FG, Pal J, et al. The Society of Thoracic Surgeons clinical practice guidelines on arterial conduits for coronary artery bypass grafting. Ann Thorac Surg. 2016;101:801–9.

    Article  PubMed  Google Scholar 

  19. Tavilla G, Bruggemans EF. Avoiding sternotomy in repeat coronary artery bypass grafting: feasibility, safety, and mid-term outcome of the transabdominal off-pump technique using the right gastroepiploic artery. J Thorac Cardiovasc Surg. 2012;144:124–9.

    Article  PubMed  Google Scholar 

  20. Hattler B, Messenger JC, Shroyer AL, et al. Off-pump coronary artery bypass surgery is associated with worse arterial and saphenous vein graft patency and less effective revascularization: Results from the Veterans Affairs Randomized On/Off Bypass (ROOBY) trial. Circulation. 2012;125:2827–35.

    Article  PubMed  Google Scholar 

  21. Takagi H, Matsui M, Umemoto T. Off-pump coronary artery bypass may increase late mortality: a meta-analysis of randomized trials. Ann Thorac Surg. 2010;89:1881–8.

    Article  PubMed  Google Scholar 

  22. Maltais S, Widmer RJ, Bell MR, et al. Reoperation for coronary artery bypass grafting surgery: outcomes and considerations for expanding interventional procedures. Ann Thorac Surg. 2017;103:1886–92.

    Article  PubMed  Google Scholar 

  23. Dohi M, Miyata H, Doi K, et al. The off-pump technique in redo coronary artery bypass grafting reduces mortality and major morbidities: propensity score analysis of data from the Japan Cardiovascular Surgery Database. Eur J Cardiothorac Surg. 2015;47:299–307.

    Article  PubMed  Google Scholar 

  24. Sepehripour AH, Saso S, Harling L, Punjabi P, Ashrafian H, Athanasiou T. Does off-pump coronary revascularization reduce mortality in re-operative coronary artery surgery? A meta-analysis of observational studies. Perfusion. 2013;28:340–9.

    Article  CAS  PubMed  Google Scholar 

  25. Azoury FM, Gillinov AM, Lytle BW, Smedira NG, Sabik JF. Off-pump reoperative coronary artery bypass grafting by thoracotomy: patient selection and operative technique. Ann Thorac Surg. 2001;71:1959–63.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This review article was funded by the Sheikh Hamdan bin Rashid Al Maktoum Distinguished Chair in Thoracic and Cardiovascular Surgery, held by Dr. Bakaeen, and the Marty and Michelle Weinberg and Family Fund.

Author information

Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/Desk J4-1, Cleveland, OH, 44195, USA

    Faisal G. Bakaeen, Zade Akras & Lars G. Svensson

Authors
  1. Faisal G. Bakaeen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zade Akras
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lars G. Svensson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Faisal G. Bakaeen.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The manuscript is a review paper and is exempt from IRB.

Informed consent

The manuscript is a review, and there are no relevant informed consent issues.

Author disclosures

None of the authors has a relevant relationship with industry to report.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bakaeen, F.G., Akras, Z. & Svensson, L.G. Redo coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 34 (Suppl 3), 272–278 (2018). https://doi.org/10.1007/s12055-018-0651-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-018-0651-1

Keywords

Search

Navigation