Complete Revascularization Using a Patent Left Internal Thoracic Artery and Variable Arterial Grafts in Multivessel Coronary Reoperation


  • Ho-Ki Min
  • Young Tak Lee
  • Wook Sung Kim
  • Ji-Hyuk Yang
  • Kiick Sung
  • Tae-Gook Jun
  • Pyo Won Park



Arterial grafting and complete revascularization are important requirements of coronary surgery to achieve optimum long-term results. In cases involving coronary artery bypass grafting reoperation (redo-CABG), it is sometimes difficult to satisfy these requirements because of the limited availability of grafts. In this study, we constructed composite and sequential grafting with a minimal number of new arterial grafts and a patent left internal thoracic artery (LITA), which sometimes is encountered in preoperative angiography, and we analyzed the results of redo-CABG.

Methods: Between January 2005 and October 2008, 29 patients underwent redo-CABG. Ten patients who had a patent LITA graft in situ were reviewed retrospectively. We performed conventional CABG in 8 patients and on-pump beating-heart CABG in 2 patients. The new arterial grafts for the composite grafts included 7 LITAs and 3 radial arteries. The types of composite grafts included 7 Y grafts, 1 K graft, 1 X graft, and 1 double-Y graft. Overall, we performed 28 distal anastomoses (mean per patient, 2.8 ± 0.7), of which 18 anastomoses were supplied from a patent LITA (mean, 1.8 ± 0.4).

Results: No hospital deaths occurred, and perioperative complications included injury to a LITA, low cardiac output, delirium, and postoperative bleeding in 1 patient each. The mean duration of follow-up was 23.6 ± 16.8 months (range, 2-46 months). There was 1 late death and no recurrent angina during the follow-up period. Follow-up coronary images obtained for 7 patients showed that all of the anastomoses were patent.

Conclusion: Composite and sequential grafting with new arterial grafts and a patent LITA is a safe and effective alternative in patients with multivessel disease undergoing redo-CABG.


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How to Cite

Min, H.-K., Lee, Y. T., Kim, W. S., Yang, J.-H., Sung, K., Jun, T.-G., & Park, P. W. (2009). Complete Revascularization Using a Patent Left Internal Thoracic Artery and Variable Arterial Grafts in Multivessel Coronary Reoperation. The Heart Surgery Forum, 12(5), E244-E249.