Redo Minimally Invasive Off-Pump Coronary Artery Bypass Surgery in Off-Pump Era
Objective: Redo CABG is still remained as a major concern to cardiac surgeons due to high risk of morbidity and mortality. Off-pump technique and redo-sternotomy-sparing minimally invasive approach could be a safe combination modality to treat successfully repeated coronary artery atherosclerosis. Therefore, we evaluate the feasibility of (redo-sternotomy-sparing) redo minimally invasive OPCAB and report their results.
Methods: From April 1998 to December 2017, 652 patients underwent CABG. Among them, we conducted OPCAB in 202 patients (31%) and redo CABG in 35 cases (5%). Among the redo CABG cases, there was no on-pump case and minimally invasive approaches were adopted in 30 cases. These 30 patients are the subjects of this study. Median age is 70 years old and all of them are male. Euroscore II is 6.45%. Time interval between 1st and redo is 10.5 years. The timing of redo is sub-classified as 1) no early (technical) failure (within 1 month), 2) mid-term (neo-intima hyperplasia-related or flow-mismatch-related) failure (within 1 year) in 3 (10%) and 3) delayed (disease progression-related) failure in 27 (90%). The reason of redo is newly-developed coronary lesion in 5 (17%) and previous graft failure in 25 (83%). Failed grafts were LIMA/RIMA-to-LAD graft in 3, non-LAD graft in 22.
Results: Median op time is 263 minutes and there was no on-pump conversion but intraoperative IABP support in 7 cases (22%). Postop ICU-stay and hospital-stay are 2 days and 14 days. There are three operative mortality (10%) and five morbidities (17%). There are three follow-up mortality cases due to MI, CHF and pneumonia at 315, 308 and 199 days. Mean survival time is 2.987 years (95% C.I. 2.361-3.614) and 6-months and 1-,3-year survival rates are 94% and 78%, 78%, respectively.
Conclusions: Conducting redo MICS off-pump CABG surgery is feasible and its results are acceptable.
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