Related Experiment Video
Updated: Jan 7, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Risk-Adjusted Outcomes of Reoperative vs Primary Coronary Artery Bypass Grafting
Darko Radakovic1, Armin Zittermann1, Carl-Thaddäus Braun1
1Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany; University Hospital of Ruhr University Bochum and Medical School Ostwestfalen-Lippe, University of Bielefeld.
Insights
Redo coronary artery bypass grafting (CABG) shows similar in-hospital mortality and long-term survival compared to first-time CABG when adjusted for patient risk. Repeat revascularization needs were higher in the redo CABG group.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is a primary treatment for advanced coronary artery disease.
- Reoperative CABG, though less common (3-7%), is crucial for patients with recurrent ischemia.
- Redo CABG presents increased complexity and risk, necessitating risk-adjusted evaluations.
Purpose of the Study:
- To compare outcomes of redo coronary artery bypass grafting (REDO-CABG) versus first-time CABG.
- To assess in-hospital mortality, perioperative complications, and long-term survival up to ten years.
- To evaluate the need for repeat revascularization after both procedures.
Main Methods:
- A single-center retrospective review of isolated CABG procedures from January 2009 to December 2023.
- Analysis included 12,120 first-time CABG and 341 REDO-CABG patients, excluding emergent cases.
- Risk-score matching, inverse probability of treatment weighting (IPTW), and multivariable adjustments were employed.
Main Results:
- Crude in-hospital mortality was 1.0% for CABG and 1.8% for REDO-CABG.
- After risk adjustment, in-hospital mortality and major perioperative complications were similar between groups.
- Ten-year survival was comparable, but REDO-CABG showed a significantly greater need for repeat revascularization.
Conclusions:
- Risk-adjusted analysis indicates that redo-CABG has comparable in-hospital mortality to first-time CABG.
- Long-term survival up to ten years is similar for both redo-CABG and first-time CABG patients.
- While outcomes are similar, redo-CABG patients require more frequent repeat revascularization.
Background:
Coronary artery bypass grafting (CABG) is a mainstay of therapy for advanced coronary artery disease. The proportion of reoperative CABG has declined to ∼3% to 7% of all CABG procedures; however, redo operations remain essential for patients with recurrent or refractory ischemia. Redo CABG involves greater technical complexity and risk, highlighting the need for risk-adjusted analyses.
Methods:
We conducted a single-center retrospective review of all isolated CABG procedures from January 2009 to December 2023. After excluding emergent cases and missing data, 12,120 first-time CABG and 341 redo-CABG patients were analyzed. We used risk-score matching, inverse probability of treatment weighting, and multivariable-adjusted approaches to assess in-hospital mortality, perioperative complications, and mortality and revascularization risks at up to 10 years of follow-up.
Results:
Crude in-hospital mortality was 1.0% in CABG vs 1.8% in redo CABG. After risk-score matching (258 pairs), in-hospital mortality was not statistically significantly different between the 2 groups (1.2% vs 1.9%; relative risk, 1.68; 95% CI, 0.40-7.10). Major perioperative complications, including stroke, myocardial infarction, hemofiltration, and extracorporeal membrane oxygenation use, were similar. However, the need for cardiopulmonary resuscitation tended to be higher in redo CABG, and repeat revascularization at up to 10 years was significantly greater in redo CABG. Both groups demonstrated comparable survival at up to 10 years of follow-up. Sensitivity analysis using the inverse probability of treatment weighting approach resulted in in-hospital mortality rates of 1.0% (CABG) and 0.8% (redo CABG), with a relative risk of 0.75 (95% CI, 0.60-0.94).
Conclusions:
In this risk-adjusted analysis, redo CABG achieved similar in-hospital mortality and 10-year survival compared with CABG.
