Redo coronary artery bypass grafting.

PURPOSE

Redo coronary artery bypass grafting (CABG) can be one of the most technically challenging operations in cardiac surgery. The coronary disease is more advanced, and the coronary targets may be suboptimal. In addition, the patients are typically older and sicker compared to those undergoing primary CABG.

METHODS

A literature review focused on the epidemiology, operative techniques, and outcomes associated with redo CABG.

RESULTS

The frequency of redo CABG relative to total CABG procedures has been decreasing over time. From 2000 to 2009, redo CABG decreased from 6.0 to 3.4% of all CABG procedures reported to the STS Adult Cardiac Surgery Database (STS ACSD) and currently stands at 2%. Risks associated with reoperations include diabetes and renal dialysis. Perioperative mortality for redo CABG is reported to be as high as three times that of primary CABG, but this risk is reduced with experience. Careful preoperative planning including quality imaging and precise surgical technique coupled with meticulous myocardial protection contributes to good outcomes. Experience is important in optimizing outcomes.

CONCLUSIONS

Redo CABG is a complicated operation and surgical experience, and appropriate perioperative strategies are essential for achieving optimal outcomes.