Aorta-sparing total arterial redo-CABG using a recycled patent LIMA: a consecutive 24-patient series with midterm clinical and computed tomographic outcomes

BACKGROUND: Redo coronary artery bypass grafting (Redo-CABG) poses significant challenges due to complex coronary anatomy and limited conduit availability. In patients with a previously patent left internal mammary artery (LIMA), reusing it as an inflow source for total arterial revascularization (TAR) may offer a durable, stroke-sparing strategy. This study evaluated the safety and midterm outcomes of reusing a patent LIMA as an inflow source in Redo-CABG. METHODS: This retrospective case series included 24 patients who underwent Redo-CABG at Faghihi and Dena Hospitals (Shiraz University of Medical Sciences) between March 2015 and October 2023. Consecutive patients were included to minimize selection bias. All patients had a patent LIMA confirmed by angiography or computed tomography angiography (CTA). Arterial grafts (right internal mammary and/or radial artery) were anastomosed to the patent LIMA to achieve complete TAR. Outcomes included perioperative complications, graft patency on CTA, and midterm major adverse cardiac or cerebrovascular events (MACCE). RESULTS: All patients achieved complete TAR with no hospital or 30-day mortality. One patient required reoperation for bleeding. Mean postoperative ejection fraction was 44.5 ± 4.6%, and mean ICU stay was 3.1 ± 0.9 days. Early postoperative CT angiography (at 3 months) and midterm follow-up imaging (median 3.5 years; completed in a subgroup of 12 patients) demonstrated complete graft patency in all evaluated conduits, with no recorded MACCE. CONCLUSIONS: Reusing a patent LIMA as an inflow source for total arterial grafting in Redo-CABG appears to be a feasible and safe alternative for high-risk patients with limited conduit options. This approach minimizes extensive aortic manipulation, potentially offering a theoretical advantage in minimizing neurological risks. However, the retrospective, single-center design and small sample size preclude definitive conclusions regarding superiority, warranting further comparative evaluation in larger multicenter studies.