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Reoperative Coronary Artery Bypass

Adam J. Hansen, Robert S. Poston, Michael Simmons.
The University of Arizona College of Medicine, Tucson, AZ, USA.

OBJECTIVE: Reoperative coronary surgery using an internal mammary artery (IMA) conduit has a well established symptomatic and survival benefit. Given that most of these reoperative cases have a prior history of left IMA usage, the right IMA (RIMA) is commonly intact and available for harvest. Minimal access revascularization procedures offer distinct advantages over standard coronary artery bypass grafting (CABG), including avoidance of reoperative sternotomy and providing the longevity benefits of a RIMA conduit without the risk of sternal healing difficulties in the setting of bilateral IMA procurement.

METHODS: We performed reoperative CABG using robot assistance in 18 patients, harvesting the RIMA through three right chest port sites. The distal left anterior descending coronary target was accessed through a left chest minithoracotomy. Patient outcomes were analyzed based on retrospective chart review.

RESULTS: Average total operative time was 232 min (range 135-306). Cardiopulmonary bypass via femoral artery and vein access was utilized in 2 patients. Average volume of donor red blood cell transfusion was 1.83 units. Average length of hospitalization was 5 days (range 3-10) and average ventilator time was 18 hrs (range 0-105). There was 0% incidence of reoperation, perioperative stroke, myocardial infarction, or renal failure at 30 days. One patient was ventilated longer than 24 hrs. There was one in-hospital death. Patency of the bypass grafts was 100% as measured by computed tomographic angiography prior to discharge.

CONCLUSIONS: Robotic-assisted reoperative CABG is beneficial for patients requiring IMA grafting to the LAD after prior failed revascularization. Complications associated with reoperative sternotomy are avoided. The technique can be safely applied to selected patients with low risk of blood transfusion and perioperative complications that often accompany reoperation.

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