Reoperation for coronary artery disease: devised management for reoperation including digital subtraction angiography

Between December 1990 and August 1999, a consecutive series of 494 patients underwent coronary artery bypass grafting, while 19 (3.8%) patients underwent isolated reoperative coronary bypass grafting. The mean age of 16 males and 3 females who underwent reoperation was 63.4 +/- 6.4 years. The mean interval from the initial operation to reoperation was 50.7 +/- 61.0 months (range 3 days to 16 years). There were neither operative nor in-hospital deaths. Postoperative graft patency was 96.9% in all the bypass grafts and 96.7% in the arterial grafts. Despite the small number of reoperations, the outcomes were favorable due to our devised management: the patients who had received coronary artery bypass grafting underwent intra-aortic digital subtraction angiography 7 days postoperatively to evaluate the early graft patency, which subsequently avoided reoperation 1 to 3 months after the initial operation when the pericardial adhesion was tight; in the primary operation, internal thoracic artery grafts were covered with thymus, and the pericardium was closed for an easy sternal re-entry; and in the reoperation, stenotic grafts were dissected and ligated after aortic cross-clamping, all sides of the heart were dissected to obtain a good operative field and to prepare for any cardiac accident, arterial grafts were used to avoid re-reoperation, and aprotinin was useful in reducing perioperative bleeding. The present findings suggest that intra-aortic digital subtraction angiography, appropriate preparation for follow-up surgery at the primary operation, and complete revascularization using arterial grafts at reoperation appear to have contributed to the satisfactory outcome in coronary reoperation.