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Multiple reoperative coronary artery bypass grafting
K D Accola1, J M Craver, W S Weintraub
1Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Insights
Third or fourth coronary artery bypass grafting (CABG) is uncommon but feasible. Despite increased risks, this reoperative CABG demonstrates acceptable in-hospital and long-term survival rates for carefully selected patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Reoperative coronary artery bypass grafting (CABG) is increasingly common.
- A subset of patients require a third or fourth CABG operation.
Purpose of the Study:
- To evaluate the safety and efficacy of third or fourth reoperative CABG.
- To assess in-hospital and long-term outcomes of these complex procedures.
Main Methods:
- Retrospective review of 53 patients undergoing third or fourth CABG between 1980 and 1990.
- Analysis of perioperative complications, mortality, and long-term survival.
Main Results:
- No intraoperative deaths; 4 in-hospital deaths.
- Perioperative complications included myocardial infarction (6), dysrhythmias (13), stroke (2), and wound infection (5).
- 3-year survival was 85%, with 70% myocardial infarction-free survival.
Conclusions:
- Third or fourth reoperative CABG carries increased risks.
- Acceptable in-hospital and long-term outcomes support its use in selected patients.
Abstract:
Initial reoperative coronary artery bypass grafting is being performed commonly, and an increasing number of patients are being referred for subsequent reoperative coronary artery bypass grafting. From January 1980 through June 1990, 53 patients (52 male, 1 female) underwent a third or fourth coronary artery bypass operation and were retrospectively reviewed. This represented 0.3% (53/17,102) of the coronary artery bypass procedures done during that time period. The mean age was 59 +/- 8 years. The number of grafts placed ranged from one to four with an average of 2.6 per patient. Internal mammary artery grafts were used in 30 patients (57%). The mean left ventricular ejection fraction was 0.52 +/- 0.13. Intraaortic balloon pump support was necessary in 10 patients postoperatively. There were no intraoperative deaths, although 4 patients died in the postoperative hospitalization period. Perioperative myocardial infarctions were diagnosed in 6 patients, 13 patients had perioperative dysrhythmias, and 2 patients sustained a stroke. Superficial wound infections occurred in 5 patients. Late follow-up in 49 patients revealed that 2 other patients have since died, and no further myocardial infarctions have been reported in the survivors. Postoperative 3-year survival is 85%, whereas 3-year myocardial infarction-free survival is 70%. Although there is increased risk of operative complications and early death after multiple reoperative coronary artery bypass grafting, both in-hospital and long-term results suggest that it is an appropriate therapeutic strategy.