Recycling of Internal Thoracic Arteries in Reoperative Coronary Surgery: In-Hospital and Midterm Results

Oumeiri, Bachar Ghassan El; Glineur, David; Price, Joel; Boodhwani, Munir; Etienne, Pierre Yves; Poncelet, Alain; Kerchove, Laurent de; Papadatos, Spiridon; Noirhomme, P.; Khoury, Gébrine El

doi:10.1016/j.athoracsur.2010.11.073

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…Successful recycling of patent ITA grafts in secondary revascularization has been described. 43,44 Secondary revascularization by PCI Compared with the inherent difficulties in repeat CABG surgery described above, catheter-based coronary revascu larization usually provides good access to the native coronary vessels and surgical grafts. This benefit probably explains why PCI is the preferred method for secondary revascularization in patients who have previously undergone CABG surgery.…”

Section: Challenges Of Repeat Cabg Surgerymentioning

confidence: 99%

Secondary revascularization after CABG surgery

Escaned

2012

Nat Rev Cardiol

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CABG surgery is an effective way to improve symptoms and prognosis in patients with advanced coronary atherosclerotic disease. Despite multiple improvements in surgical technique and patient treatment, graft failure after CABG surgery occurs in a time-dependent fashion, particularly in the second decade after the intervention, in a substantial number of patients because of atherosclerotic progression and saphenous-vein graft (SVG) disease. Until 2010, repeat revascularization by either percutaneous coronary intervention (PCI) or surgical techniques was performed in these high-risk patients in the absence of specific recommendations in clinical practice guidelines, and within a culture of inadequate communication between cardiac surgeons and interventional cardiologists. Indeed, some of the specific technologies developed to reduce procedural risk, such as embolic protection devices for SVG interventions, are largely underused. Additionally, the implementation of secondary prevention, which reduces the need for reintervention in these patients, is still suboptimal. In this Review, graft failure after CABG surgery is examined as a clinical problem from the perspective of holistic patient management. Issues such as the substrate and epidemiology of graft failure, the choice of revascularization modality, the specific problems inherent in repeat CABG surgery and PCI, and the importance of secondary prevention are discussed.

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Section: Challenges Of Repeat Cabg Surgerymentioning

confidence: 99%

Secondary revascularization after CABG surgery

Escaned

2012

Nat Rev Cardiol

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“…[3] In a contemporary study by Oumeiri recycling of LIMA graft had a 91% at 1 year and 83% at 5 years freedom from major cardiac events. [4] Length of hospital stay and length of stay in intensive care unit were shown to be comparable to nonrecycled graft CABGs with 69 hour mean intensive care stay and 14 day mean hospital stay. [5] The unusual medical history of these patients may have contributed to the success of our re-use of the LIMA graft; there may be more patients with similar histories in which this procedure can be considered.…”

Section: Discussionmentioning

confidence: 88%

Internal mammary artery conduit re-use in coronary artery bypass grafting: Case series and review

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Imielski

Tomlin

et al. 2016

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Left internal mammary artery (LIMA) conduit is the gold standard graft for coronary artery bypass. Due to excellent patency rates with this graft it can safely be used in re-operative coronary bypass surgery. The safety of this technique is demonstrated with our report of re-used LIMA conduits in patients with extensive coronary artery disease (CAD). The success of this technique was evaluated by postoperative computerized tomographic angiography which demonstrated patent conduits and flow to the left anterior descending artery (LAD).

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“…El Oumeiri et al [2] have published a large retrospective series of 60 patients who underwent redo CABG using previously implanted ITAs. Using a variety of operative techniques, patients had redo surgery with a mean time to reoperation of 117 ± 68 months.…”

Section: Resultsmentioning

confidence: 99%

Reusing the patent internal mammary artery as a conduit in redo coronary artery bypass surgery: Table 1:

Nwaejike¹,

Tennyson²,

Mosca³

et al. 2015

Interact CardioVasc Thorac Surg

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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with previous internal mammary artery/internal thoracic artery (ITA) grafts, can the internal mammary artery/ITA be reused/recycled in redo coronary artery bypass surgery? Fourteen papers were found using the reported search of which 10 represented the best evidence to answer the clinical question. There was variation in patient selection, the number of patients reported, outcome measures recorded, and methods and duration of follow-up. The results were mostly in favour of using a recycled ITA when it could be safely harvested. Most studies were retrospective. One large series of 60 patients who underwent redo coronary artery bypass grafting (CABG) using previously implanted ITAs had a mean time to reoperation of 117 ± 68 months. They reported no operative deaths; no patients required further or subsequent target vessel revascularization; 30-day mortality was 8.3% and myocardial infarction rate was 3%. Another two series of 16 and 12 patients underwent recycling of arterial grafts during coronary artery revascularization with no perioperative deaths in either. Postoperative angiography was performed in 10 patients in one of these studies, which showed excellent flow in all redone left internal thoracic artery (LITA) grafts. One study reported results from a prospective cohort of 9 patients who underwent redo coronary artery bypass grafting. Interval between operations was between 1 and 132 months. There was no perioperative mortality, but 1 patient required reintervention (to an interposition vein graft). A further study of 4 patients who underwent redo CABG using ITAs that were patent but with severe stenosis at the distal anastomosis had no mortality. Postoperative angiography showed patency of all grafts. There have also been 4 case reports on reusing the ITA/ITA in redo CABG with no damage to the reused LITA, no perioperative mortality and satisfactory follow-up at up to 29 months. Evidently, the recycled ITA can be used in redo coronary artery bypass grafting. Papers found were retrospective series or case reports. As such, there is no direct comparison in outcomes between the recycled ITA and first-time ITA harvest or any other conduit for CABG. In conclusion, we find that when it is possible to harvest a previously used ITA, studies have shown it to be a safe and viable conduit in redo CABG with good long-term outcomes.

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Recycling of Internal Thoracic Arteries in Reoperative Coronary Surgery: In-Hospital and Midterm Results

Cited by 6 publications

References 15 publications

Secondary revascularization after CABG surgery

Secondary revascularization after CABG surgery

Internal mammary artery conduit re-use in coronary artery bypass grafting: Case series and review

Reusing the patent internal mammary artery as a conduit in redo coronary artery bypass surgery: Table 1:

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