Minimally Invasive Off Pump Redo Cabg With Right Gastro-epiploic Artery Graft: A Real Deal
Amber Malhotra, Daniel Beckles, Giuseppe Tavilla, Ramachandra Reddy.
Baylor Scott and White Health, Temple, TX, USA.
BACKGROUND: Patients with prior CABG, needing a graft to the right coronary circulation and a patent LIMA (Left Internal Mammary Artery) present a particular challenge for revascularization. PCI (Percutaneous Coronary Intervention) is often not an option due to long segment occlusions or previous unsuccessful attempts. Re-sternotomy carries a risk to the LIMA. The minimal access RGEA (Right Gastro-epiploic Artery) graft to the PDA (Posterior Descending Artery) is an option in these patients. METHODS: We report 3 such patients with recalcitrant angina due to inferior wall ischemia, unsuccessful stent placement, a patent LIMA to LAD and stress studies that showed inferior ischemia and viability. The PDA was approached through a lower midline sternal incision and upper midline laparotomy incision about 10 cms in length. The RGEA was harvested in a skeletonized fashion to its proximal origin from the gastro duodenal artery. The conduit was then brought into the pericardial sac through a small opening in the diaphragm after lysis of adhesions. RESULTS: One patient presented with symptoms of heart failure, the other two presented with angina. The mean EF was 34 with a range of 20 to 55%. One patient had end stage renal disease and was on dialysis. 2 patients required an endarterectomy of the PDA. There were no conversions to sternotomy, CPB assistance or reinterventions for bleeding. There was no perioperative mortality, respiratory failure or atrial fibrillation and the mean length of stay was 4 days. No stroke or deep wound infection occurred. At a mean follow up of 18 months (range 2 - 48) all patients continue to do well with no recurrence of angina.
CONCLUSIONS:MICS RGEA in a redo revascularization situation is feasible, safe and associated with excellent procedural and early outcomes.
Back to 2022 Display Posters