Injury to a patent left internal thoracic artery graft at coronary reoperation

Background. The purpose of this study was to determine the prevalence, outc ome, and operative strategies for patients having injury to a patent left i nternal thoracic artery (LITA) graft to the left anterior descending corona ry artery (LAD) at coronary reoperation. Methods. Of 655 patients with a patent LITA graft to the LAD undergoing cor onary reoperation from 1986 to 1997, 35 (5.3%) sustained intraoperative inj ury to the LITA graft, Results. Strategies-to restore now to the LAD included new saphenous vein g raft to the LAD in 15 patients, saphenous vein graft to the LITA stump in 7 , saphenous vein graft to the LAD and repair of the LITA graft in 6, and of her strategies in 7 All or part of the LITA graft to the LAD was salvaged in 20 patients (57%). Fourteen patients (40%) sustained perioperative myoca rdial infarction, and 3 patients died (8.6%). The 3 patients who died all h ad stenosis or thrombosis of the graft to the LAD documented at autopsy. Conclusions. We conclude that (1) the prevalence of injury to a patent LITA graft is 5.3%; (2) a variety of techniques can be used to restore blood fl ow to the LAD; and (3) ineffective revascularization of the LAD in this sit uation is associated with operative mortality. At primary coronary artery b ypass grafting, the LITA pedicle should be positioned in the left chest awa y from the posterior sternal table; this strategy may minimize the risk of LITA graft injury at coronary reoperation. (C) 1999 by The Society of Thora cic Surgeons.