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[Four cases of third time operation of coronary artery bypass grafting]
T Ishida1, H Nishida, Y Tomizawa
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan.
Insights
Repeat coronary artery bypass surgery is becoming more common. For patients needing a second reoperation, saphenous vein grafts remain essential due to difficulties with arterial grafts.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
Background:
- Reoperative coronary artery bypass grafting (CABG) is increasing, leading to more patients requiring repeat revascularization.
- This study retrospectively investigated four cases of second reoperation for coronary artery bypass grafting.
Observation:
- Out of 2,563 isolated CABG procedures, 124 (4.8%) were reoperations, and 4 (3.2%) were second reoperations.
- Patients undergoing second reoperation had an average age of 51.1 years at their primary operation.
- No internal thoracic artery (ITA) grafts were used in the primary operations for these cases.
Findings:
- One hospital death and two perioperative myocardial infarctions occurred, requiring intraaortic balloon pump support.
- Three patients were discharged with symptom relief.
- Incomplete revascularization occurred in two cases due to ungraftable coronary arteries.
Implications:
- Achieving complete revascularization with arterial grafts during repeat operations is challenging due to graft availability.
- Saphenous vein grafts continue to be a necessary option for achieving complete revascularization in repeated reoperative CABG.
- Further strategies are needed to optimize graft selection and improve outcomes in complex reoperative CABG scenarios.
Abstract:
Reoperative coronary artery bypass operations are increasing in frequency. Consequently, an ever-increasing pool of patients now is being seen with need of coronary revascularization for repeated time. Four cases of second reoperation were retrospectively investigated. Until March 1999, 2,563 cases of isolated coronary artery bypass grafting were done at the Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan. Within those cases, 124 cases (4.8%) were reoperated. And among those 124 cases, 4 cases (3.2%) were secondly reoperated. There were one hospital death and two had a perioperative myocardial infarction. All of them needed intraaortic balloon pump support after operation. Three were discharged with relief of the symptoms. The average age at the primary operation was 51.1 years. All these cases, at the primary operation, no ITA graft was used. Two cases were incompletely revascularized, because of coronary arteries were ungraftable. Both at reoperation and at second reoperation, we are trying to make a complete revascularization by all arterial grafts. But because of limited number of arterial graft at repeated operation, all arterial complete revascularization is not done without difficulty. Therefore it is concluded that saphenous vein graft is still needed at repeated operation.