Redo Coronary Artery Bypass Grafting

  • Hitoshi YakuEmail author
  • Sachiko Yamazaki
  • Satoshi Numata


Redo coronary artery bypass grafting (CABG) is a more demanding procedure than primary CABG because the patient’s condition is usually worse with many pitfalls in the surgical technique and limited availability of conduits. The number of redo CABG procedures is on the decline as patients more frequently have arterial grafts at the primary CABG while percutaneous coronary intervention (PCI) is performed quite aggressively for patients with previous CABG requiring reintervention. The early surgical outcomes of redo CABG are improving; however, mortality remains three times higher than that of primary CABG. On the other hand, once patients survive the early surgical period, the effect of coronary revascularization by redo CABG appears to be the same as that of primary CABG and may be better than that of PCI. To improve early surgical outcomes by eliminating adverse effects of cardiopulmonary bypass, off-pump CABG may be a preferred procedure, even in redo CABG. There are several studies indicating that in-hospital mortality of off-pump redo CABG is lower than that of on-pump. Advances in technical aspects including off-pump strategy, retrograde cardioplegia, use of arterial grafts, and alternative approaches to re-median sternotomy may improve early and late surgical results for patients who require redo CABG. This chapter provides an overview of technical aspects and outcomes of redo CABG.


Diseased vein graft Early graft failure Repeat coronary artery bypass surgery Repeat revascularization Sternal re-entry 


  1. 1.
    Sabik JF III, 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.CrossRefGoogle Scholar
  2. 2.
    Yaku H, Doi K. Redo coronary artery bypass grafting. Gen Thorac Cardiovasc Surg. 2014;62:453–60.CrossRefGoogle Scholar
  3. 3.
    Sousa-Uva M, Neumann FJ, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40:87–165.CrossRefGoogle Scholar
  4. 4.
    Ito K, Yaku H, Shimada Y, Kawata M, Kitamura N. Left ventricular apex venting during deep hypothermia in a case of difficult re-entry into the mediastinum. J Cardiovasc Surg. 2001;42:493–4.Google Scholar
  5. 5.
    Kamdar AR, Meadows TA, Roselli EE, Gorodeski EZ, Curtin RJ, Sabik JF, Schoenhagen P, White RD, Lytle BW, Flamm SD, Desai MY. Multidetector computed tomographic angiography in planning of reoperative cardio-thoracic surgery. Ann Thorac Surg. 2008;85:1239–46.CrossRefGoogle Scholar
  6. 6.
    Ohira S, Doi K, Numata S, Yamazaki S, Yamamoto T, Yaku H. Reskeletonization of patent graft using ultrasonic scalpel in redo surgery. Ann Thorac Surg. 2014;98:e153–5.CrossRefGoogle Scholar
  7. 7.
    Glineur D, Noirhomme P, Poncelet A, Hanet C, Astarci P, Verhelst R, Etienne PY, El Khoury G. Gastroepiploic artery minimally invasive grafting in reoperative patients with patent. Ann Thorac Surg. 2005;79:1606–9.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    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.CrossRefGoogle Scholar
  10. 10.
    Fazel S, Borger MA, Weisel RD, et al. Myocardial protection in reoperative coronary artery bypass grafting: towards decreasing morbidity and mortality. J Card Surg. 2004;19:291–5.CrossRefGoogle Scholar
  11. 11.
    Yau TM, Borger MA, Weisel RD, Ivanov J. The changing pattern of reoperative coronary surgery: trends in 1230 consecutive reoperations. J Thorac Cardiovasc Surg. 2000;120:156–63.CrossRefGoogle Scholar
  12. 12.
    Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularization on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet. 2001;358:870–5.CrossRefGoogle Scholar
  13. 13.
    Taggart DP, Benedetto U, Gerry S, et al. Bilateral versus single internal-thoracic-artery grafts at 10 years. N Engl J Med. 2019;380:437–46.CrossRefGoogle Scholar
  14. 14.
    Dohi M, Doi K, Okawa K, Yaku H. Upgrading redo coronary artery bypass graft by recycling in situ arterial graft. Ann Thorac Surg. 2014;98:311–4.CrossRefGoogle Scholar
  15. 15.
    Yap CH, Sposato L, Akowuah E, et al. Contemporary results show repeat coronary artery bypass grafting remains a risk factor for operative mortality. Ann Thorac Surg. 2009;87:1386–91.CrossRefGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    Cole JH, Jones EL, Craver JM, et al. Outcomes of repeat revascularization in diabetic patients with prior coronary surgery. J Am Coll Cardiol. 2002;40:1968–75.CrossRefGoogle Scholar
  18. 18.
    Hlatky MA, Boothroyd DB, Bravata DM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomized trials. Lancet. 2009;373:1190–7.CrossRefGoogle Scholar
  19. 19.
    Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet. 2018;391:939–48.CrossRefGoogle Scholar
  20. 20.
    Morrison DA, Sethi G, Sacks J, et al. Percutaneous coronary intervention versus repeat bypass surgery for patients with medically refractory myocardial ischemia: AWESOME randomized trial and registry experience with post-CABG patients. J Am Coll Cardiol. 2002;40:1951–4.CrossRefGoogle Scholar
  21. 21.
    Thielmann M, Massoudy P, Jaeger BR, et al. Emergency re-revascularization with percutaneous coronary intervention, reoperation, or conservative treatment in patients with acute perioperative graft failure following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2006;30:117–25.CrossRefGoogle Scholar
  22. 22.
    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 Database. Eur J Cardiothorac Surg. 2015;47:299–308.CrossRefGoogle Scholar
  23. 23.
    Bruno VD, Zakkar M, Rapetto F, et al. Early health outcome and 10-year survival in patients undergoing redo coronary surgery with or without cardiopulmonary bypass: a propensity score-matched analysis. Eur J Cardiothorac Surg. 2017;52:945–51.CrossRefGoogle Scholar
  24. 24.
    Shin YR, Lee S, Joo HC, Youn Y-N, Kim JG, Yoo KJ. Early and midterm outcome of redo coronary artery bypass grafting: on-pump versus off-pump bypass. Korean J Thorac Cardiovasc Surg. 2014;47:225–32.CrossRefGoogle Scholar
  25. 25.
    Mack MJ. Off-pump surgery and alternatives to standard operation in redo coronary surgery. J Card Surg. 2004;19:313–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Hitoshi Yaku
    • 1
    Email author
  • Sachiko Yamazaki
    • 1
  • Satoshi Numata
    • 1
  1. 1.Department of Cardiovascular SurgeryKyoto Prefectural University of MedicineKyotoJapan

Personalised recommendations