Reoperation for coronary atherosclerosis. Changing practice in 2509 consecutive patients

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Trends Analysis

Background:

• Reoperation for myocardial revascularization is a complex procedure with evolving patient demographics and indications.
• Understanding long-term outcomes and trends is crucial for optimizing surgical strategies.

Purpose of the Study:

• To analyze trends in clinical, angiographic, and operative variables for myocardial revascularization reoperations.
• To document long-term survival rates and identify factors influencing outcomes over a 20-year period.

Main Methods:

• Analysis of 2509 consecutive patients undergoing reoperation for myocardial revascularization from 1967 to 1987.
• Patients were stratified into four surgical year cohorts to assess temporal trends.
• Evaluation of indications for reoperation, patient characteristics, operative details, and survival data.

Main Results:

• Vein graft atherosclerosis emerged as the leading indication for reoperation, with increasing patient age and time between surgeries.
• Hospital mortality rates remained low (2.9% in 1985-1987), despite rising comorbidity and worse left ventricular function.
• Perioperative myocardial infarction rates decreased, and internal thoracic artery graft use significantly increased (27% to 67%).

Conclusions:

• Advanced age and left main coronary artery disease negatively impacted late survival.
• Improved survival in earlier cohorts was linked to fewer risk factors.
• Factors associated with better 10-year survival included younger age, less comorbidity, good left ventricular function, and internal thoracic artery grafting.