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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
[Early results of coronary artery bypass reoperations in own experience]
Tomasz Hirnle1, Marek Pelczar, Wojciech Kustrzycki
1Klinika Chirurgii Serca Akademii Medycznej, Wrocław. hirnlet@wp.pl
Insights
Using arterial grafts during initial Coronary Artery Bypass Grafting (CABG) reduces the need for reoperation (RE-CABG). RE-CABG patients are older, more frequently women, and face higher mortality and IABP use compared to primary CABG.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Context:
- Coronary Artery Disease (CAD) management often involves Coronary Artery Bypass Grafting (CABG).
- Recurrent symptoms and the need for reoperation (RE-CABG) can occur despite initial CABG.
- Assessing outcomes of RE-CABG is crucial for refining treatment strategies.
Purpose:
- To evaluate the outcomes of reoperation for Coronary Artery Bypass Grafting (RE-CABG) in a specific patient cohort.
- To compare the characteristics and in-hospital results of RE-CABG versus primary CABG.
Summary:
- A study of 3452 CABG and 37 RE-CABG patients (1995-2002) found arterial grafts in primary CABG significantly decreased reoperation rates.
- RE-CABG patients were older (60.7 vs 57.9 years) and had a higher proportion of women (40.5% vs 22%) compared to CABG.
- In-hospital mortality was higher in the RE-CABG group (8.1%) than the CABG group (5%), with increased Intra-Aortic Balloon Pump (IABP) use in RE-CABG (16.2% vs 7.8%).
Impact:
- The findings suggest that utilizing arterial grafts during the initial CABG procedure can lower the incidence of subsequent reoperations.
- RE-CABG is associated with increased patient age, higher female representation, and elevated mortality and complication rates, highlighting the need for careful patient selection and management.
- This study provides valuable data for surgeons and clinicians managing patients with recurrent coronary artery disease requiring reoperation.
Unlabelled:
Coronary Artery Bypass Grafting (CABG) is widely accepted as an effective and durable method of treatment of Coronary Artery Disease. In some patients however, recurrent angina and the necessity of reoperation (RE-CABG) occurs.
Aim:
The aim of the study is the estimation of the results of RE-CABG in own material.
Material And Methods:
In years 1995-2002 CABG operations were performed in 3452 patients (CABG group) and RE-CABG in 37 pts (1.07%) (RE-CABG group). Patients were considered for operation on condition of the presence of symptomatic CAD confirmed by coronarography in standard projections. Operations were performed using Cardiopulmonary Bypass.
Results:
The CABG group consisted of 3452 pts in mean age 57.9 years, including 2693 men (78%) and 759 (22%) women. The RE-CABG group was composed of 37 pts in mean age 60.7 years, comprising 22 (59.5%) men and 15 (40.5%) women. The percentage of women in CABG group was significantly higher than in CABG group. The mean age in RE-CABG group was insignificantly higher than in CABG group. In the CABG group 3.1 anastomosis/pt were performed, including anastomosis IMA to LAD in 2779 pts (80.5%). From this group only in 2 pts (0.07%) coronary reoperations were performed. In the remaining 673 pts from CABG group during the first operation, only saphenous vein graft were performed and in 35 (5.2%) coronary reoperation was necessary. This difference is statistically significant. In-hospital mortality in CABG group was 5%, the IABP was used in 7.8% of pts. Mortality in the RE-CABG group reached 8.1% (3/37), the IABP was used in 16.2% (6/37).
Conclusions:
1. The use of arterial grafts during the first coronary operation decreases the reoperation rate. 2. RE-CABG are performed in the older patient rather than CABG. 3. RE-CABG are performed more frequently in women than in men as compared to CABG. 4. RE-CABG are burdened with twice as high mortality rate and the necessity of use of IABP than CABG.
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