Resettling of patent left internal thoracic artery grafts from LAD to a new territory – a surgical strategy to reserve right internal thoracic artery as a second arterial conduit for the LAD in redos

Objectives: Failure of saphenous vein grafts (SVG), in presence of patent left internal thoracic artery (LITA)-grafts may cause necessity of redo in coronary artery bypass grafting (CABG). Aim of the present study was to convert unilateral- to bilateral in situ ITA-grafting in redo-cases which had a patent LITA and occluded SVG.

Methods: 8 male patients (mean age 64.1±6.6 years) with occluded SVG and patent LITA to LAD were re-operated between 10/01 and 5/06 after an interval of 8.7±2.7 years (range 4.8–11.8 years) between primary and re-operation. LITAs were resettled to circumflex artery, LAD was re-grafted with right internal thoracic artery (RITA) using cardiopulmonary bypass. We analyzed peri-/postoperative mortality, serious events and clinical outcome. Distal segments of 5 recycled LITAs and new harvested RITAs were investigated histomorhological.

Results: We observed a 30-day mortality-rate of 0%. In one patient RITA anastomosis was revised without delay due to low-cardiac-output and additional bypasses were performed to the posterior wall. Postoperatively this patient suffered from a temporary multi-organe-failure. One re-thoracotomy was caused by bleeding. In hospital stay was 12±6 days. Histomorphological analysis of all 5 LITA-segments did not identify any severe stenosis.

Conclusion: Resettling of previous used and patent LITAs to achieve the benefit of in situ bilateral ITA grafting, which avoids aortic manipulation, may represent a feasible procedure.