[Risk factors in patients with recurrent coronary heart disease]

Progression of the coronary heart disease (CHD) and early occlusion of the coronary artery bypass grafts (CABG) represent significant problems for patients after myocardial revascularisation. Between November 1984 and August 1988 121 patients underwent surgery for a second and 3 patients for a third myocardial revascularisation. The mean age at the time of the second and third operation was 59 and 62 years, respectively. The mean interval between the first and second operation was 5.4 years, between the second and third 4.0 years. The indications for reoperation were graft stenosis or occlusion (graft dysfunction) in 43 patients (35%), progression of CHD in 25 patients (25%) and graft dysfunction as well as progression of CHD in 56 patients (45%). During the reoperation 109 patients received new venous CABG, whereas 15 patients were given an IMA-bypass graft, either solely or in addition to venous CABG. The IMA-grafts implanted during the first operation were patent in all 6 patients. They did, however, in some cases cause considerable preparatory difficulties during the reoperation. Perioperative complications were: low-output-syndrome in 9 patients (4 x lethal), myocardial infarction in 5 patients (1 x lethal), malignant ventricular cardiac dysrhythmia in 5 patients (2 x lethal), postoperative bleeding in 3 patients and cerebrovascular insufficiency in 2 patients. The perioperative lethality amounted to 5.7% (n = 5). The results of our retrospective study indicate that one third of the patients had to undergo a reoperation primarily as a result of graft dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)