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Published on: March 27, 2018
What are the predictors that affect the excellent long-term benefits of redo coronary artery bypass grafting?
Ayyaz Ali1, Darryl Ramoutar, Hutan Ashrafian
1Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom.
Insights
Redo coronary artery bypass grafting (CABG) offers acceptable long-term survival and symptom relief for patients with recurrent angina. However, specific risk factors like poor left ventricular function and radial artery graft use require careful consideration.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Coronary Artery Disease Management
Background:
- Recurrent angina after initial coronary artery bypass grafting (CABG) often necessitates repeat surgical revascularization.
- Managing patients with refractory angina post-CABG presents significant clinical challenges.
Purpose of the Study:
- To evaluate the long-term survival and freedom from cardiac events following redo CABG.
- To identify predictors of surgical efficacy and adverse outcomes in repeat revascularization procedures.
Main Methods:
- Retrospective analysis of 101 patients undergoing redo CABG between 1996 and 2004.
- Kaplan-Meier survival analysis and Cox proportional hazards modeling for risk factor identification.
- Composite endpoint defined as angina class ≥2, NYHA class ≥2, myocardial infarction, or need for percutaneous intervention.
Main Results:
- 30-day mortality was 1.2%; mean follow-up was 5.3 years.
- Poor left ventricular function and pre-operative NYHA class ≥2 independently predicted decreased survival.
- Radial artery graft use was associated with increased peri-operative death (OR=18).
- Actuarial survival at 8 years was 76.9%; freedom from cardiac events at 8 years was 68%.
Conclusions:
- Redo CABG provides acceptable short- and long-term survival and symptom relief at a single institution.
- Pre-operative patient factors significantly influence outcomes.
- The association between radial artery grafts and adverse early outcomes requires further investigation.
Objective:
Recurrent angina refractory to medical therapy in patients having undergone prior coronary artery bypass grafting (CABG) is an indication for repeat surgical revascularisation. The primary aim of this retrospective study was to determine the benefit of redo surgery over the longer term with regards to survival and freedom from cardiac symptoms/events. Our secondary aim was to identify risk factors that compromise surgical efficacy of redo revascularisation.
Methods:
Patients were identified through case note review. Survivors were interviewed by telephone according to a defined protocol. Actuarial freedom from cardiac symptoms/events and survival were determined. A composite outcome for cardiac symptoms/events was used and defined as angina class> or =2 or NYHA> or =2 or myocardial infarction or need for percutaneous intervention. Univariate and multivariate analysis was performed. Survival was assessed using a Kaplan-Meier method, and determinants of survival with the Cox proportional hazards model.
Results:
Between January 1st, 1996 and February 1st, 2004, 101 consecutive patients underwent redo CABG at our institution under the care of a single surgeon. There were 91 men and 10 women, 64% (65/101) had an age> or =70 years. 30-Day mortality was 1.2% (2/101). Mean time to follow-up was 5.3+/-3.8 years. Poor left ventricular function and pre-operative NYHA> or =2 status were independent predictors of decreased survival with hazard ratios (HR) of 2.12 (1.042-4.31) and 3.98 (1.39-11.39) respectively. The use of a radial artery graft at re-operation was an independent predictor of peri-operative death OR=18 (1-346). Actuarial survival at 1, 5 and 8 years was 90.1%, 84.4% and 76.9% and freedom from cardiac symptoms/events was 100%, 95% and 68% respectively.
Conclusion:
This study shows acceptable short- and long-term survival and freedom from symptoms/events in patients undergoing redo coronary artery bypass grafting at a single institution. The apparent association between radial arterial grafts and impaired early clinical outcome warrants further investigation.
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