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Reoperative coronary artery bypass grafting: analysis of early and late outcomes
Michele Di Mauro1, Angela L Iacò, Marco Contini
1Division of Cardiac Surgery, G D'Annunzio University, Chieti, Italy.
Insights
Redo coronary artery bypass grafting (CABG) had higher rates of complications and worse long-term outcomes than first-time CABG. Achieving complete revascularization is key for successful redo CABG surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Reoperative CABG (redo CABG) is performed when initial bypasses fail or new blockages develop.
- Comparing outcomes of first-time versus redo CABG is crucial for surgical planning and patient management.
Purpose of the Study:
- To compare the early and late clinical outcomes of reoperative coronary artery bypass grafting (redo CABG) with those of first-time coronary artery bypass grafting (first CABG).
Main Methods:
- A retrospective analysis of 4,381 patients undergoing isolated coronary revascularization between 1994 and 2001.
- 274 patients (6.3%) underwent redo CABG.
- Propensity score matching created a cohort of 239 redo CABG patients (group R) and 239 first CABG patients (group F).
Main Results:
- Early mortality was similar between groups (2.1% in group F vs. 4.2% in group R).
- Redo CABG patients experienced significantly higher creatine kinase myocardial band (CK-MB) release, longer ICU stays, and more incomplete revascularization.
- Five-year outcomes were worse for redo CABG, with redo identified as an independent risk factor for mortality and adverse cardiac events.
Conclusions:
- Complete revascularization is the primary goal of redo CABG surgery.
- Minimizing myocardial damage during redo procedures is essential.
- The study suggests that achieving results comparable to the first CABG is attainable with careful surgical technique.
Background:
The purpose of this study was to evaluate early and late results of reoperative coronary artery bypass grafting compared with those of first coronary artery bypass grafting.
Methods:
From November 21, 1994, to December 31, 2001, 4,381 patients underwent isolated coronary revascularization: among these patients, 274 (6.3%) underwent a redo. Applying the propensity score, 239 redo patients (group R) were matched with 239 who underwent the first revascularization (group F).
Results:
Early mortality was 2.1% (group F) and 4.2% (group R), not significantly different. Group R showed significantly higher creatine kinase myocardial band release, length of intensive care unit stay, and incidence of incomplete myocardial revascularization than group F. In group R, off-pump patients showed higher incidence of incomplete revascularization. Redo was a risk factor for abnormal (>19 IU/L) creatine kinase myocardial band release (odds ratio, 1.7; p = 0.0066) and incomplete myocardial revascularization (odds ratio, 2.4; p = 0.0060). Five-year clinical outcome was significantly worse in group R, except for freedom from redo or percutaneous transluminal coronary angioplasty. Redo was an independent variable for lower freedom from death of any cause, cardiac death, acute myocardial infarction, cardiac events, and any event. Patients with higher creatine kinase myocardial band release or incomplete myocardial revascularization showed lower freedom from cardiac-related events. Incidence of incomplete myocardial revascularization and creatine kinase myocardial band release were significantly higher in group R by both univariate and multivariate analysis. This could explain the worse late outcome of redo patients.
Conclusions:
Complete revascularization without damaging the heart, whichever technique is used, is the target of redo surgery, to achieve the same quality of results obtained in the first operation.
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