Myocardial revascularization. Early and late results after reoperation

In a series of 4,522 consecutive patients who underwent aorta-coronary bypass (ACB) with the saphenous vein at the Texas Heart Institute, 32 had a second revascularization procedure. All patients were reoperated upon because of recurrence of incapacitating angina. Reappearance of angina was related to obstruction of the grafts alone in 6 patients, to the disease of other arteries alone in 16, and to both sources in the remaining 10 patients. In 9 patients progression of the native coronary disease was found, in 16 significant coronary obstructions had been left unbypassed at the time of initial operation, and in the remaining 7 patients inadequate indication and/or performance of revascularization was considered responsible for the failure. Of the 31 survivors, 61 per cent experienced complete relief of angina or were improved, whereas 39 per cent were unimproved. Reoperation was more successful in relieving angina when performed in patients with new lesions or with previously unbypassed lisions than when done in patients with graft occlusion. Incidence of myocardial infarction after the first and second procedure was similar (3 per cent). Reoperation was performed with a mortality rate of 3 per cent, comparable to that of the original procedure, but relief of angina was not achieved so consistently.