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J Thorac Cardiovasc Surg 2005;129:1180-1182
© 2005 The American Association for Thoracic Surgery
Brief Communications |
Deutsches Herzzentrum Berlin, Berlin, Germany.
Received for publication September 20, 2004; accepted for publication September 27, 2004. * Address for reprints: Professor Miralem Pasic, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany (E-mail: pasic{at}dhzb.de).
When used as an aorta-coronary bypass graft, the left internal thoracic artery (LITA) might remain open, despite significant restriction of flow through the graft. Potentially, a patent but nonfunctioning LITA might be reharvested and reused for repeat coronary artery bypass surgery (so-called LITA recycling). We report on our experience with successful reimplantation of the LITA during redo bypass surgery in 12 patients.
Patients and methods
Between 1997 and 2003, the LITA was reharvested and reinserted in 12 patients undergoing repeat coronary artery bypass grafting. There were 3 women and 9 men. The mean ± SD age of the patients was 64 ± 7 years (range, 53–74 years). Written informed consent was obtained from all patients. The patients’ mean left ventricular ejection fraction was 38% ± 16% (range, 25%-60%). The patent but nonfunctioning LITA was reused only if preoperative coronary angiography showed that the diameter of the LITA lumen was normal or almost normal. This was assessed by the respective surgeon according to his experience, and he considered it to be feasible.
The causes of LITA dysfunction were anastomotic problems in 7 patients and progression of atherosclerotic disease of the native vessel distal to the previous anastomosis in 5 patients. Stenosis of the anastomosis between the LITA and the left anterior descending coronary artery (LAD; Figure 1) was found in 5 patients and between the LITA and another vessel in 2 patients. Two patients had minimally invasive bypass grafting (off pump) in another institution and were referred to our hospital for redo operations. Reimplantation of the LITA was performed 6 months to 11 years (mean, 4.3 ± 3 years) after the first operation. In 7 patients with anastomotic problems, the interval between the first LITA implantation and LITA reimplantation ranged between 6 months and 6.6 years (mean, 2.6 ± 2.3 years). In 5 patients with distal progression of the atherosclerotic process in the native coronary artery, the interval was between 2.1 and 11 years (mean, 6.5 ± 2.8 years).
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The reimplantation of a patent but nonfunctioning LITA graft is an infrequent clinical situation for which no evidence-based therapeutic strategy is established. Our experience shows that the reuse of a patent but nonfunctioning LITA graft is a feasible, safe, and effective option in selected situations. There was no early mortality, and the midterm postoperative results were excellent.
The incidence of the patent but nonfunctional LITA is very low because the LITA has the best patency among all bypass grafts for coronary artery revascularization. There are only exceptional reports on the reimplantation of a LITA graft during repeat coronary artery bypass revascularization and only in few patients.1–6 Although our experience includes only 12 patients, it represents the worldwide largest experience in dealing with reuse of the LITA. The results are favorable and encourage further use of such patent but nonfunctional arterial grafts. Therefore, we suggest that the reimplantation of the LITA graft should be used in ideal circumstances.
References
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