The evolution of repeat coronary artery surgery

As has been seen in primary coronary artery bypass surgery (CABG), the patient population undergoing surgical secondary revascularisation (RECABG) has changed during the last twenty years. An increasing number of older patients, with more coexisting disease, are presented for RECABG. Beside the demographic changes, there are also changes as a part of the results of the different strategies used in CABG. The extensive use of arterial grafts in CABG results in an increase of the event-free period and of the period between CABG and RECABG. But results also show a challenge for RECABG with a patent arterial graft. Also, routine use of antiplatelet drugs and statins after CABG have an influence on the patient population presented for secondary revascularisation. Probably the most important aspect here is the evolution in percutaneous coronary intervention (PCI), especially in combination with a patent arterial graft protecting part of the myocardium. The purpose of this paper is to review the evolutionary trends in the patient population undergoing secondary revascularisation.