Extra-anatomic redo of MIDCAB and OPCAB: An early experience

Background: Eighteen patients with unstable angina underwent repeat myocard ial revascularization without cardiopulmonary bypass using saphenous vein g rafts from either the left (13) or right (2) axillary arteries or the desce nding thoracic aorta (3). Patients' ages ranged from 53 to 85 years. Left v entricular ejection fractions ranged from 15% to 60%. Methods: In 14 patients, the heart was exposed through an anterior thoracot omy, a minimally invasive direct coronary artery bypass (MIDCAB) technique. In 3 patients a left posterolateral thoractomy (lateral MIDCAB) was perfor med. One patient underwent repeat sternotomy (off-pump coronary artery bypa ss: OPCAB). In MIDCAB and lateral MIDCAB patients, the "target" vessel was a coronary artery in 8 patients and a previously placed vein graft in the r emaining 9 patients. One patient underwent repeat sternotomy, and 3 coronar y arteries were bypassed with a complex vein graft attached to the left axi llary artery. Two patients died of mesenteric ischemia on the 2nd and 7th p ostoperative day. The remainder of patients were discharged from the hospit al free of angina. Early graft patency was demonstrated by noninvasive vasc ular laboratory testing and/or angiography in the 13 survivors in whom the axillary artery had been the site of the proximal anastomosis. Results: Follow-up ranged from 1 to 25 months. No other patients have died, and none have undergone additional surgical or catheter-based procedures. Three patients have developed recurrent angina, and in 4 patients the extra anatomic bypass grafts have apparently become occluded. Conclusion: Extra-anatomic, off-pump bypass from the axillary artery or des cending thoracic aorta to one or more coronary arteries can be performed sa fely in seriously ill patients requiring a repeat bypass procedure. The ear ly results, regarding relief of angina, are encouraging.