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Reoperations for myocardial revascularization.

M J Irarrazaval, D M Cosgrove, F D Loop

    The Journal of Thoracic and Cardiovascular Surgery
    |February 1, 1977
    PubMed
    Summary
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    Reoperations for myocardial revascularization showed low mortality despite high morbidity. Secondary graft patency was favorable, indicating successful outcomes for repeat coronary artery bypass surgery.

    Area of Science:

    • Cardiovascular Surgery
    • Cardiac Surgery Outcomes
    • Coronary Artery Disease Management

    Background:

    • Reoperation for myocardial revascularization addresses graft failure, progressive atherosclerosis, and incomplete revascularization.
    • Previous surgical interventions included bypass grafts, mammary artery implants, and combined procedures.

    Purpose of the Study:

    • To evaluate the outcomes of reoperations for myocardial revascularization.
    • To assess mortality, morbidity, symptom relief, and graft patency in patients undergoing repeat coronary artery bypass surgery.

    Main Methods:

    • A consecutive series of 219 patients undergoing reoperation for myocardial revascularization between 1967 and 1975.
    • Analysis of indications for reoperation, primary and reoperation procedures, and postoperative complications.

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  • Long-term follow-up of survivors, including clinical assessment (N.Y.H.A. class) and postoperative arteriography.

    • Main Results:

    • Low operative mortality (3.7%) with significant morbidity including hepatitis, myocardial infarction, bleeding, and respiratory insufficiency.
    • Symptom relief (N.Y.H.A. Class I or II) achieved in 81-93% of survivors, with similar outcomes regardless of reoperation indication.
    • High graft patency rate (84%) observed in secondary grafts, with 19 of 22 grafts patent in cases of primary graft failure.

    Conclusions:

    • Reoperation for myocardial revascularization is feasible with low mortality, though associated with high morbidity.
    • Significant symptom relief is achievable in a majority of survivors.
    • Favorable patency rates for secondary grafts support the efficacy of repeat revascularization procedures.