Recycling of the LIMA Graft in Off Pump Re-CABG to Achieve Total Arterial Revascularization

This video presents a case of an off pump redo CABG using a recycled left internal mammary artery (LIMA) graft in combination with the right internal mammary artery (RIMA) and the right gastroepiploic artery (GEA).

The patient was a sixty-five-year-old male, who arrived in the emergency room with a ST-elevation myocardial infarction (STEMI). Seventeen years earlier, he had undergone a primary CABG with a LIMA to the left anterior descending artery (LAD) and two single venous grafts on the obtuse marginal branch and the descending posterior artery. The patient had a poor left ventricle function with an ejection fraction of 16 percent. Coronary angiography of the right coronary artery showed an occluded distal right with a diseased large acute marginal branch. On the left system, there was an occluded distal LAD, an occluded distal obtuse marginal artery, and a diseased large diagonal branch. Both venous grafts were occluded while the LIMA was still patent without runoff to the LAD. The surgeons planned to recycle the LIMA graft to revascularize the LAD, use the RIMA for the diagonal branch, and use the GEA to revascularize the large acute marginal branch. The postoperative course was uneventful, and the patient was discharged on postoperative day six.