Reoperation for recurrent coronary artery disease--a ten year experience
1Department of Cardiothoracic Surgery, St George Hospital, Sydney, NSW, Australia.
Insights
Coronary artery reoperation is increasingly common and can be performed with low mortality, similar to primary bypass grafting. Careful technique ensures improved outcomes for patients needing repeat coronary artery bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Coronary artery disease recurrence necessitates reoperation, posing surgical challenges.
- Reoperation for coronary artery disease is becoming more frequent.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery reoperation.
- To assess outcomes and mortality rates for repeat coronary artery bypass grafting.
Main Methods:
- Retrospective analysis of 172 patients undergoing coronary artery reoperation between 1981 and 1990.
- Comparison of reoperation outcomes with primary coronary artery bypass grafting mortality rates.
Main Results:
- In-hospital mortality was 1.2% (2 deaths) in 172 reoperations.
- No postoperative neurological deficits or myocardial infarctions occurred.
- Six-month to five-year follow-up showed eight late deaths, with symptom improvement in survivors.
Conclusions:
- Coronary artery reoperation can be performed with acceptable mortality and morbidity.
- Careful surgical technique is crucial for successful coronary artery reoperation.
- Consideration of reoperation challenges is vital during primary myocardial revascularization planning.
Abstract:
The need for reoperation caused by recurrence of coronary artery disease is becoming increasingly common. Although reoperation is more difficult and time-consuming, with careful surgical technique it can be carried out with the same mortality as that described by many units for primary coronary artery bypass grafting (1.2-2.0%). In the 172 patients described here, who had coronary artery reoperations between 1981 and 1990, there were two in-hospital deaths (1.2%). There were three postoperative bleeds which required return to theatre. No patient suffered a postoperative neurological deficit or postoperative myocardial infarction. These reoperations comprised 6.9% of the 2497 coronary artery operations carried out in the same period. Follow-up disclosed eight late deaths, from five-62 months after operation; all survivors claim to be symptomatically improved. Consideration should be given to the potential problems of reoperation when carrying out primary myocardial revascularisation.
