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Coronary artery bypass grafting for the third time or more. Results of 150 consecutive cases
J B Brenowitz1, W D Johnson, K L Kayser
1St. Mary's Hospital, Milwaukee, Wisconsin.
Insights
This study on repeat coronary artery bypass surgery found that advanced age and reduced left ventricular ejection fraction were significant risk factors for early mortality. Five-year survival rates were 76.4% overall.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for ischemic heart disease.
- Repeat revascularization procedures are increasingly performed in patients with prior cardiac surgeries.
- Evaluating outcomes in patients undergoing repeat CABG is crucial for surgical planning and patient management.
Purpose of the Study:
- To assess the outcomes of repeat coronary artery bypass surgery in patients with multiple prior revascularization procedures.
- To identify risk factors associated with early mortality and complications in this high-risk patient cohort.
- To evaluate long-term survival rates following repeat CABG.
Main Methods:
- Retrospective analysis of 150 patients who underwent repeat CABG (≥2 previous revascularizations) through December 1986.
- Detailed data collection on patient demographics, preoperative conditions, surgical procedures (including coronary artery endarterectomy), in-hospital outcomes, and long-term follow-up.
- Statistical analysis to identify risk factors for early mortality.
Main Results:
- 150 patients underwent repeat CABG, with a mean of 3.3 grafts and 46.7% requiring coronary artery endarterectomy.
- In-hospital mortality was 12.0% (18 deaths).
- Age over 65 and left ventricular ejection fraction <0.40 were significant risk factors for early mortality (p<0.01).
- Five-year actuarial survival was 76.4% for the entire series and 87.3% for hospital survivors.
Conclusions:
- Repeat coronary artery bypass surgery in patients with extensive prior revascularization is associated with significant early mortality.
- Patient age and left ventricular function are critical determinants of early survival.
- Despite high-risk factors, long-term survival can be achieved in a substantial proportion of patients.
Abstract:
Through December 1986, coronary artery bypass surgery was performed on 150 patients who had undergone at least two previous myocardial revascularization surgeries. One hundred thirty-seven patients had two, 12 patients had three, and one patient had four previous operations. There were 117 men (78.0%); the mean age was 55.5 years (range, 28-76 years); 137 patients (91.3%) had triple-vessel disease, and 36 (24.0%) had a left ventricular ejection fraction less than 0.40. One hundred forty-nine patients (99.3%) had angina preoperatively, with 142 (94.7%) having Class III and IV angina. Direct myocardial revascularization was performed in all patients, with a mean of 3.3 grafts per patient (range, 1-6). In addition, coronary artery endarterectomy was performed in 70 cases (46.7%): right coronary artery endarterectomy in 15 (10.0%), left coronary artery endarterectomy in 39 (26.0%), and multiple coronary artery endarterectomies in 16 (10.7%). There were 18 in-hospital deaths (12.0%). Statistically significant risk factors for increased early mortality (p less than 0.01) included age over 65 years and left ventricular ejection fraction less than 0.40. Diffuse coronary artery disease requiring multiple coronary artery endarterectomies almost achieved statistical significance as a risk factor (p = 0.06). Complications in the surviving 132 patients included seven nonfatal perioperative myocardial infarctions (5.3%). Follow-up data for a period of 8-172 months (mean, 43.1 months) is available for 100 of 103 patients (97.1%). Five-year actuarial survival was 76.4% for the entire series and 87.3% for hospital survivors.(ABSTRACT TRUNCATED AT 250 WORDS)