Extension of the right internal thoracic artery with the radial artery in extensive re-do coronary artery bypass grafting

BACKGROUND: Patients with extensive coronary artery disease often require re-do coronary artery bypass grafting. However, autologous bypass material is sometimes sparse. Since long term patency of arterial graft material is superior to venous bypass grafting, we developed a technique to perform re-do total arterial coronary artery bypass grafting extending the right internal thoracic artery (RITA) with the radial artery (RA) in an end to end fashion to gain the needed length in patients with and without an open left thoracic artery (LITA). METHODS: We performed this approach in 27 consecutive patients (age: 67.93 ± 7.51 years). Data was analyzed retrospectively. 19 operations were first re-op, 6 were second re-op and two were third re-op procedures. RESULTS: Cardiopulmonary bypass time was 115.42 minutes (±31.92 minutes) with one OPCAB procedure, and clamp time was 55.09 minutes (±22.41 minutes) excluding 10 procedures performed on beating heart. Bypass grafting included the RCA, Cx and LAD. An average of 1.96 anastomoses were performed in each patient. Complication rate was low with one intra-operative apoplexy and one prolonged wound healing after harvest of the radial artery. One patient needed long term pulmonary assist. There was no intra-operative or early postoperative death. CONCLUSION: The operational technique of elongation of the internal thoracic artery with the radial artery proved to be safe and feasible with acceptable operation times for a re-do procedure. We recommend this as an additional option to existing methods to perform a complete arterial revascularization mainly in patients with open left internal thoracic artery to LAD bypass.