Reimplantation of the left internal thoracic artery during repeat coronary artery revascularization

Objectives: When used as an aortocoronary bypass graft, the left internal thoracic artery [LITA] may remain open despite significant restriction of flow through the graft. Potentially, a patent but non-functioning LITA can be re-used for repeat coronary artery bypass revascularization. The aim of this study is to analyze the results of LITA re-use for repeat aortocoronary artery bypass grafting.

Material and Methods: The LITA was re-harvested and re-implanted during redo cardiac surgery in 12 patients (mean age, 64±7 years; range, 53 to 74 years). The causes of LITA dysfunction were anastomotic problems in 7 patients and progression of atherosclerotic disease of the native vessel distal to the previous anastomosis in 5. Re-implantation of the LITA was performed 6 months to 11 years (mean, 4.3±3 years) after first surgery.

Results: The LITA was directly re-inserted into the distal LAD in 9 patients and in 3 patients prolonged with a short venous segment before re-insertion. There were no technical problems during surgery and the postoperative course was uneventful in all patients. The mean follow-up after surgery was 4.4±2.4 years (range, 4 months to 7 years). Postoperative coronary artery angiographic examination was performed in 10 patients (two patients refused angiography because they had no symptoms). The examination demonstrated patent LITA grafts with excellent flow. No stenosis was found in any graft.

Conclusions: A patent but non-functioning LITA graft may be re-used for repeat coronary artery bypass surgery with excellent early and mid-term postoperative results.