Outcomes and Challenges of Redo Coronary Artery Bypass Grafting: A Propensity-Matched Comparative Analysis

This study aims to compare the perioperative and long-term outcomes of reoperative coronary artery bypass grafting (CABG) with primary CABG in a propensity score-matched patient cohort.

We retrospectively analyzed 2,021 patients who underwent CABG between January 2003 and January 2024. Among them, 35 (1.7%) patients underwent redo CABG. Using 1:1 propensity score matching based on age, ejection fraction, diabetes mellitus, and hypertension, 36 patients who underwent primary CABG were selected for comparison. Patients with incomplete records or combined cardiac procedures were excluded. Perioperative variables, in-hospital mortality, and long-term survival were analyzed.

The redo CABG group had significantly longer intensive care unit stays (2.15 ± 2.37 vs. 1.39 ± 1.36 days, P = 0.006), hospital stays (12.11 ± 17.40 vs. 7.36 ± 2.21 days, P = 0.009), and postoperative bleeding (899.12 ± 445.17 vs. 576.39 ± 323.92 ml, P = 0.001). Hospital mortality occurred in two patients (5.7%) in the redo group and one patient (2.8%) in the primary group (P = 0.614). Kaplan-Meier survival analysis showed higher long-term survival in the redo CABG group (77.1%) compared to the primary CABG group (58.3%), though not statistically significant (P = 0.168).

Despite the increased perioperative complexity, redo CABG is associated with low in-hospital mortality and promising long-term outcomes when appropriate patient selection and meticulous surgical technique are employed. These findings are especially relevant in guiding revascularization strategies for patients with prior CABG, where redo surgery is often underutilized despite its clinical viability.