Reoperative Coronary Artery Bypass Surgery
Patients who undergo reoperative coronary artery bypass grafting (redo CABG) are often older and have more comorbidities than those who undergo primary CABG. Adding to the associated operative risk is that redo CABG is technically more demanding than primary CABG. Sternal reentry may be complicated by the proximity of cardiovascular structures, including previous bypass grafts that could be at risk for injury. Furthermore, dissecting out the heart and exposing the coronary targets may be complicated by scar tissue that causes difficulty in identifying dissection planes, resulting in additional risk of injury to patent conduits and cardiovascular structures. Inadvertent manipulation of diseased conduits can result in thromboembolic complications and myocardial ischemia or infarction. Effective myocardial protection is important in redo CABG, but anatomic limitations, including severe diffuse native coronary disease or areas supplied by occluded grafts, may compromise the antegrade delivery of cardioplegia. Patent left internal thoracic arteries in redo CABG patients add another layer of complexity in intraoperative management.
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