ABSTRACT 85

TARGETED REDO-OFF PUMP CORONARY ARTERY BYPASS-A SAFER APPROACH

Murali Dharan, MD, Pramodh Sidhu, MD, Ray Engstrom, MD, Shahroukh Bakhshay, MD
Bay Area Heart Institute, San Ramon Regional Medical Center
San Ramon, CA 94583 USA

Purpose: Redo CABG is associated with higher mortality and morbidity.  The purpose of this study was to determine if off-pump techniques using different approaches have facilitated Redo CABG, decreasing the morbidity and mortality. 

Methods: We analyzed 17 patients between January 2000 to November 2000 who underwent Redo-OPCAB.  11 underwent a first time redo OPCAB, 3 underwent a second time Redo OPCAB and 3 patients underwent a third time Redo OPCAB.  Approaches used were a full redo sternotomy (n= 9), anterior-lateral thoracotomy (n=3) for LAD & diagonal targets, posterior-lateral thoracotomy (n= 4) for OM targets, transdiaphragmatic abdominal approach (n=1) for RCA targets.  The mean age of this group was 66.4.  Proximal anastomosis was performed to ascending aorta (n=9), axillary artery (n=3), descending aorta (n=4), intact proximal LIMA (n=1).  LIMA was used in 2 patients, and the RIMA in 4 patients.

Summary of Results: There were no operative deaths.  Post operative complications included bleeding (n=2), one requiring takeback to OR The average length of intubation time was 7.5 hours (range 0-80 hours), 7 patients were extubated in the OR, and prolonged ventilation time, more than 8 hours occurred in two patients.  The average number of grafts was 1.7 for sternotomy patients, and 1.0 for thoracotomy patients.  Blood products were used in 3 patients. The average length of stay was 3.3 (range 1-8 days).  There were no other complications.

Conclusions:  A targeted approach in performing Redo CABG offers a less invasive, but safer method of myocardial revascularization with decreased complications and LOS.