Redo Coronary Artery Bypass Grafting

Abstract

Redo coronary artery bypass grafting (CABG) is a more demanding procedure than primary CABG because the patient’s condition is usually worse with many pitfalls in the surgical technique and limited availability of conduits. The number of redo CABG procedures is on the decline as patients more frequently have arterial grafts at the primary CABG while percutaneous coronary intervention (PCI) is performed quite aggressively for patients with previous CABG requiring reintervention. The early surgical outcomes of redo CABG are improving; however, mortality remains three times higher than that of primary CABG. On the other hand, once patients survive the early surgical period, the effect of coronary revascularization by redo CABG appears to be the same as that of primary CABG and may be better than that of PCI. To improve early surgical outcomes by eliminating adverse effects of cardiopulmonary bypass, off-pump CABG may be a preferred procedure, even in redo CABG. There are several studies indicating that in-hospital mortality of off-pump redo CABG is lower than that of on-pump. Advances in technical aspects including off-pump strategy, retrograde cardioplegia, use of arterial grafts, and alternative approaches to re-median sternotomy may improve early and late surgical results for patients who require redo CABG. This chapter provides an overview of technical aspects and outcomes of redo CABG.