Early cardiac contractility outcome of reoperative coronary artery bypass grafting using right gastroepiploic artery

Abstract

Background and aim of the study Reoperative coronary artery bypass grafting (redo CABG) still carries higher mortality and increased morbidity compared with primary CABG. In this study, we retrospectively reviewed our operative outcome of redo CABG to evaluate the impact of the left anterolateral thoracotomy approach using the right gastroepiploic artery (RGEA). Methods Between 1994 and 2020, 11 patients (mean age 60.3 ± 13.1 years; nine men, two women) underwent isolated redo CABG using the RGEA via the left anterolateral thoracotomy. Results The mean duration from the initial CABG was 128.3 ± 88.4 months. Redo CABG was performed because of graft occlusion in six patients (54.5%), graft stenosis in one patient (9.1%), and progressive disease of previously ungrafted vessels in four patients (36.4%). The total number of bypasses using RGEA (including Y‐composite vein grafts) was 16 (four left anterior descending branches, two diagonal branches, five circumflex branches, five right coronary arteries). No residual graft injury, major comorbidity, or in‐hospital death was observed. Changes in echocardiographic values before and after redo CABG were 210.9 ± 48.2 ml and 175.0 ± 41.4 ml in left ventricular end‐diastolic volume, 130.2 ± 49.2 ml and 94.4 ± 33.0 ml in left ventricular end‐systolic volume, and 45.6 ± 11.0% and 52.2 ± 10.7% in left ventricular ejection fraction, respectively. These parameters significantly improved after redo CABG. Conclusions Redo CABG with RGEA grafting via the left anterolateral thoracotomy approach is a safe and effective surgical procedure especially in improving cardiac contractility in patients who required revascularization.

Expanding the armamentarium for reoperative coronary artery bypass grafting

“…Shiraishi et al 7 present an interesting and topical premise. Historically, the RGEA was first proposed for indirect myocardial revascularization in the 1960s 8 .…”

“…In this issue of the journal, Shiraishi et al 7 document the outcomes of reoperative CABG using the right gastroepiploic artery (RGEA) through a left anterolateral thoracotomy at a single cardiac center 7 . The goals of the study are to specifically examine perioperative morbidity and mortality and to assess the impact of reoperative CABG with RGEA grafting through a left anterolateral thoracotomy by evaluating cardiac functional values between pre‐ and postoperative status.…”

“…The transdiaphragmatic approach facilitates avoidance of both full sternotomy and cardiopulmonary bypass. 7 Since that time, others have described off-pump reoperative CABG using the RGEA, primarily to the right coronary artery circulation. [11][12][13][14][15] Nevertheless, the RGEA is an infrequently used bypass conduit.…”

“…That same year, Suma et al 10 described the use of RGEA for reoperative coronary revascularization of the left anterior descending artery through a transdiaphragmatic approach in two patients. The transdiaphragmatic approach facilitates avoidance of both full sternotomy and cardiopulmonary bypass 7 . Since that time, others have described off‐pump reoperative CABG using the RGEA, primarily to the right coronary artery circulation 11–15 .…”

“…As Shiraishi et al 7 concede, RGEA use should be limited to select appropriate bypass candidates. This judicious patient selection is reflected in their small cohort size.…”