Alternative approaches in off-pump redo coronary artery bypass grafting

BACKGROUND: The recent development of off-pump and minimally invasive techniques in coronary artery bypass grafting (CABG) has provided the surgeon with multiple options in performing redo revascularization procedures. METHODS: We retrospectively analyzed our early results in off-pump redo CABG procedures. Between January 1998 and January 2000, we performed 55 off-pump redo CABG procedures: 25 through a full sternotomy, 21 through a left posterolateral thoracotomy, 5 using a lower hemi-sternotomy and 4 using a mini anterior thoracotomy with thoracoscopic internal mammary artery harvesting. The mean age of this group was 67.7 years (range 37-85). The mean number of grafts performed in earlier operations was 2.7 (range 1-6) with 51% of grafts still partially or fully open at the time of re-operation. Twenty-six patients (47.3%) had a functioning left internal mammary artery graft to left anterior descending. Preoperative clinical severity scoring predicted a mortality of 9% and morbidity of 30%. RESULTS: There were no operative or thirty-day infarctions or deaths. Morbidity included pulmonary complications (8), renal failure (1) and bleeding (1) for a total complication rate of 18.9%. The average number of grafts performed was 2.7 (range 1-5) for sternotomy patients and 1.4 (range 1-3) for thoracotomy patients. CONCLUSIONS: By employing alternative approaches in performing off-pump redo CABG procedures, the surgeon can often avoid injury to pre-existing patent internal mammary grafts as well as the morbidity associated with the use of cardiopulmonary bypass.