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Myocardial revascularization for the third time. Clinical characteristics and follow-up
B P Blakeman1, N J Thomas, H J Sullivan
1Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL.
Abstract:
Twenty-five patients presenting for a third revascularization procedure were retrospectively reviewed at Loyola University Medical Center, Maywood, IL. This represents 0.5 percent of the total revascularization cases over a five-year period extending from 1985 through 1989. Perioperative mortality was none, and seven complications occurred in six patients. Internal mammary arteries were used for revascularization in 60 percent of this group. Follow-up reveals that only one patient has died secondary to an arrhythmia. All patients except one are symptomatically improved, and 18 patients remain angina free at a mean follow-up of 22.3 months. It is therefore concluded that patients are clinically improved with a third revascularization, and this procedure should be offered as an effective means of treatment.
Insights
Third revascularization procedures offer significant clinical improvement for patients with coronary artery disease. This treatment is effective, with most patients remaining symptom-free and angina-free post-procedure.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) often necessitates multiple revascularization procedures.
- The efficacy of a third revascularization procedure is less established than earlier interventions.
Purpose of the Study:
- To evaluate the clinical outcomes and safety of a third revascularization procedure for CAD.
- To determine the long-term symptom relief and survival rates in patients undergoing repeat revascularization.
Main Methods:
- Retrospective review of 25 patients undergoing a third revascularization procedure between 1985-1989.
- Analysis of perioperative complications, mortality, and long-term follow-up data.
- Assessment of symptom status and freedom from angina.
Main Results:
- No perioperative mortality was observed.
- Seven complications occurred in six patients.
- Internal mammary arteries were utilized in 60% of cases.
- One late death occurred due to arrhythmia.
- 18 patients (72%) remained angina-free at a mean follow-up of 22.3 months.
- All but one patient reported symptomatic improvement.
Conclusions:
- Third revascularization procedures can lead to significant clinical improvement in carefully selected patients.
- This procedure is a safe and effective treatment option for patients with recurrent symptoms despite previous interventions.
- Long-term angina-free survival is achievable, supporting the consideration of repeat revascularization.