A 20-year experience in coronary artery reoperation

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Graft Patency

Background:

• Coronary artery reoperation is increasingly complex due to diffuse atherosclerosis and left ventricular dysfunction.
• Vein graft atherosclerosis is the primary indication for repeat coronary artery bypass grafting.
• Understanding temporal trends in reoperation outcomes is crucial for surgical planning.

Purpose of the Study:

• To evaluate the trends in indications, operative mortality, morbidity, and graft patency in isolated coronary artery reoperations over a 20-year period.
• To assess the impact of evolving surgical practices and patient populations on reoperation outcomes.
• To compare the long-term results of reoperation with those of primary coronary artery bypass grafting.

Main Methods:

• Retrospective analysis of 2518 patients undergoing isolated coronary artery reoperation between 1967 and 1987.
• Patients were divided into four time-based cohorts to analyze temporal trends.
• Data collected included indications for reoperation, operative mortality, perioperative complications (myocardial infarction, hemorrhage), blood usage, and graft patency.

Main Results:

• The interval between surgeries increased from 50 to 101 months. Vein graft atherosclerosis was the leading indication.
• Operative mortality remained stable, with a 2.7% hospital mortality in the latest cohort (1985-1987).
• Perioperative myocardial infarction rates significantly decreased (4.0% in the latest cohort), attributed to improved myocardial protection. Postoperative hemorrhage rates remained unchanged. Internal thoracic artery and vein graft patency were 94% and 67%, respectively. Approximately 50% of patients were angina-free at 10 years, lower than after primary surgery.

Conclusions:

• Coronary artery reoperation can be performed with acceptable mortality and morbidity, even in a sicker patient population.
• Improvements in myocardial protection have reduced perioperative myocardial infarction rates.
• Long-term angina-free survival after reoperation is suboptimal compared to primary surgery, highlighting the need for durable graft solutions and continued management of atherosclerosis.