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Coronary artery reoperations. Early and late results in 101 patients
T S Ivert1, S Ekeström, A Péterffy
1Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
Insights
Coronary artery reoperation carries significant risks, including hemorrhage and graft damage. While many patients experience symptom relief, full recovery is rare, suggesting it should be reserved for severe angina cases.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
Background:
- Coronary artery reoperation involves repeat surgical intervention for coronary artery disease.
- Previous studies highlight the complexities and risks associated with repeat sternotomy and cardiac procedures.
Purpose of the Study:
- To evaluate the outcomes and risks of coronary artery reoperation.
- To assess the impact of internal mammary artery (IMA) grafts on reoperation results.
Main Methods:
- Retrospective analysis of 101 patients undergoing coronary artery reoperation between 1972 and 1985.
- Detailed review of surgical complications, graft patency, and long-term patient follow-up.
Main Results:
- Major hemorrhage occurred in 12 cases; 38% of patent internal mammary artery (IMA) grafts were damaged.
- Five-year survival was 90%. Symptomatic improvement was reported by 82%, with 22% angina-free, but only 3% regained full fitness.
- 35% of non-retired patients returned to work.
Conclusions:
- Coronary artery reoperation presents increased surgical risks and limited likelihood of complete symptom relief.
- Careful consideration is warranted, particularly for patients with severe angina and those with patent IMA grafts requiring special caution.
Abstract:
Coronary artery reoperation was performed on 101 patients between 1972 and 1985. The resternotomy was associated with major hemorrhage in 12 cases. Of 29 patent internal mammary artery (IMA) grafts, 11 (38%) were damaged during mobilization of the left ventricle. At reoperations performed more than a year after the initial operation, increased graft blood flow compared with the first operation was observed in IMA but not in vein grafts. There were six early deaths (6%). The 5-year survival rate, inclusive of early mortality, was 90%. After a median of 2.5 years, 82% of the patients reported symptomatic improvement and 22% were completely free from angina, but full physical fitness was restored in only 3%. Excluding the patients of retirement age, 35% were able to resume work after the reoperation. Coronary artery reoperation should be considered only for patients with severe angina, because of the increased surgical risk and the lower likelihood of completely relieved symptoms. Presence of a patent IMA graft necessitates special caution.