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Summary
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.