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The Journal of Thoracic and Cardiovascular Surgery, Vol 87, 379-385, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Reoperation in patients with patent atherosclerotic coronary vein grafts. A different approach to a different disease

CM Grondin, JL Pomar, Y Hebert, X Bosch, JM Santos, M Enjalbert and L Campeau

Atherosclerotic changes are often noted in vein grafts at angiography 8 to 10 years after coronary artery grafting. Reoperation in these patients is hazardous, as manipulation of the grafts may loosen atheromatous debris and cause coronary embolization and myocardial infarction. A technique is described to avoid embolization of atheromatous material during reoperation in patients with patent atherosclerotic coronary vein grafts. This technique was carried out in six patients and compared to the standard technique of reoperation in similar patients. The incidence of complicated perioperative myocardial infarction (0/6 versus 5/12) and perioperative death (zero versus three) was lower when our new technique was used. This approach consists of minimal dissection for access to the right atrium and ascending aorta for cannulation, prompt ligation of all patent grafts at the start of cardiopulmonary bypass, cardioplegic infusion through the ascending aorta and subsequently also through newly inserted grafts using larger infusions until myocardial temperatures reach less than or equal to 15 degrees C, and single aortic clamping for distal and proximal anastomoses.

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