Objectives: Recycling of previously grafted internal thoracic artery (ITA) is an elegant technique to maximize arterial revascularization in redo-CABG. Techniques of recycling and outcomes were analysed in elective re-operations.
Methods: Between 1996 and 2006, out of 4257 isolated CABG, 230 were redo-CABG and 36 benefited from ITA recycling. Mean age was 63.9 + 9.4 years. Interval to reoperation was 103 + 72 months. Indications were: graft failure in 10 patients, coronary artery disease progression in 4 and both in 22. All previously implanted left ITA (LITA) were patent (36/36), as well as 80 % of right ITA (RITA) (8/10) and 9 % of saphenous vein graft (SVG) (3/35).
Results: Patent LITA was used as donor in the Y graft to RITA in 21 patients, to radial artery (RAD), to gastro-epiploic artery (GEA) and to a SVG in 2 patients each. Anastomosis problem of patent ITA (12 LITA and 5 RITA) was resolved by distally moving anastomosis on the coronary vessel. Mean CCS score was 3.1 + 0.86 and mean logistic Euroscore was 10.4. Four patients died in hospital (2 cardiac-related deaths) (11%). The LITA was recycled in 30 cases, RITA in 2 and both in 4. New grafts used were 20 RITA, 10 RAD, 3 GEA and 12 SVG. A total of 89 anastomoses were performed (82% arterial). Twenty four patients (67%) had complete arterial revascularization after recycling. Mean hospital stay was 13 days with a mean ICU stay of 4 days. Follow-up (77.3 mo) was 91% complete. Four patients died during follow-up (3 cardiac-related deaths). There was only one re-re-revascularization (PTCA at 104 months after redo-operation).
Conclusions: ITA recycling in redo-CABG is a feasible and a useful technique, with similar mortality risks than classical redo-procedures. It might improve late outcomes due to a more complete arterial revascularization.