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Repeat coronary artery bypass grafting (CABG) offers a 90% 5-year survival rate, comparable to initial procedures. However, symptomatic relief from angina is less effective after reoperation, with only half of patients remaining angina-free.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Repeat coronary artery bypass grafting (CABG) constitutes 5% of myocardial revascularization procedures in the US.
- Nearly 7000 reoperations were projected for 1984.
- Indications include graft obstruction, coronary arteriosclerosis, and graft failure with new disease.
Purpose of the Study:
- To review the indications, technical considerations, and outcomes of repeat CABG.
- To compare repeat CABG with initial procedures regarding mortality, morbidity, survival, and symptomatic relief.
Main Methods:
- Review of angiographic indications for repeat CABG.
- Discussion of surgical technical considerations for aortocoronary reoperation.
- Analysis of operative mortality, morbidity, survival rates, and symptomatic relief post-reoperation.
Main Results:
- Operative mortality for repeat CABG is approximately double that of initial procedures.
- Overall operative morbidity is similar between primary and repeat CABG.
- Five-year survival after repeat CABG is around 90%, comparable to initial CABG.
- Only 50% of patients are angina-free 5 years after repeat surgery, less than after initial CABG.
- Long-term graft patency favors internal artery grafts over saphenous vein grafts.
Conclusions:
- Repeat CABG is a viable option with favorable long-term survival.
- Symptomatic relief of angina is a significant limitation after repeat CABG.
- Graft choice, particularly the use of internal artery grafts, is crucial for long-term patency.
Abstract:
Repeat coronary artery bypass grafting (CABG) accounts for approximately 5% of all myocardial revascularization procedures in the United States annually; it is estimated that nearly 7000 reoperations will be performed in 1984. Angiographic indications for repeat CABG include primary bypass graft obstruction, progressive coronary arteriosclerosis, and combined graft failure and new coronary artery disease. Saphenous vein obstruction secondary to arteriosclerosis occurs in more than half the bypass grafts at 10 years after CABG. Successful aortocoronary reoperation is dependent on careful attention to special surgical technical considerations such as chest reentry, cardiopulmonary bypass management and myocardial preservation, primary graft handling and identification of the target coronary vessel, choice of available bypass conduits, completeness of revascularization, and hemostasis and blood conservation. Operative mortality for repeat CABG is approximately twice that for an initial aortocoronary bypass procedure. Overall operative morbidity is not significantly different for primary and subsequent myocardial revascularization. Five-year survival after repeat aortocoronary surgery is approximately 90% and compares favorably with survival rates after initial CABG. However, symptomatic relief of angina pectoris is not as effective after a repeat myocardial revascularization as it was after the first CABG; only half the patients are angina-free 5 years after reoperation. As with primary revascularization, long-term graft patency rates after coronary reoperation are superior for the internal artery as compared with the saphenous vein.