title: Cardiac and Aortic Reoperation for Patients with Functional Grafts after CABG.
abstract: OBJECTIVE
  Late cardiac and aortic reoperation after CABG is indispensable for patients with atherosclerotic disease, but reoperations are still associated with high morbidity rates.
  
  
  METHODS
  Between January 2002 and December 2010, 459 patients underwent coronary artery bypass grafting. Six patients (males; mean age, 65.0 ± 5.7 years) with previous arterial bypass grafts (mean, 2.8 ± 1.2 per patient) required reoperation for cardiac and aortic disease (3, valvular disease; 3, acute type I aortic dissection) during long-term follow-up. The mean interval between the initial operation and reoperation was 5.4 ± 2.0 years. Grafts visualized by preoperative enhanced computed tomography were harvested as pedicles and clamped for myocardial protection. The total arch or ascending aorta was replaced in three patients. The aortic valve was replaced in two patients, and the aortic and mitral valves were replaced in one.
  
  
  RESULTS
  Durations for surgery, total cardiopulmonary bypass, and cardiac ischemia were 611.5 ± 172.6, 223.2 ± 88.4, and 133.4 ± 58.0 minutes, respectively. Perioperative myocardial infarction did not develop, and all patients recovered uneventfully with no neurological deficits.
  
  
  CONCLUSIONS
  Bypass grafts should be preoperatively visualized and carefully exposed. Cardiac damage must be avoided during reoperation after coronary artery bypass grafting.
authors.affiliation: Thoracic and Cardiovascular Surgery Division, Ryukyu University Hospital, Nishihara, Okinawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashiro
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Yukiko
authors.forename: Yuya
authors.initials: Y
authors.lastname: Kise
authors.forename: Ryoko
authors.initials: R
authors.lastname: Arakaki
keywords: aortic dissection; cardiac reoperation; coronary artery bypass grafting; internal thoracic artery
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