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Late clinical and arteriographic results in 500 coronary artery reoperations
Insights
Coronary artery reoperations offer significant palliation, with 86% experiencing angina relief. Graft patency rates are high, especially for mammary artery grafts, ensuring long-term survival benefits.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Coronary Artery Disease Management
Background:
- Coronary artery reoperations are performed in a subset of patients with advanced coronary artery disease.
- Progression of disease and graft failure are common indications for reoperation.
- Left ventricular function can decline significantly between initial and repeat surgeries.
Purpose of the Study:
- To evaluate the outcomes of coronary artery reoperations.
- To compare different surgical techniques and indications for reoperation.
- To assess long-term graft patency and patient survival after reoperation.
Main Methods:
- Analysis of 500 consecutive coronary artery reoperations performed between 1967 and 1979.
- Categorization of patients into three indication groups: progressive atherosclerosis, graft failure, or combined.
- Comparison of outcomes between normothermic anoxic arrest and hypothermic cardioplegia techniques.
Main Results:
- 86% of patients experienced angina relief or improvement post-reoperation.
- High graft patency rates observed: 79% for vein grafts and 97% for mammary artery grafts.
- Actuarial 5-year survival rates ranged from 87.4% to 91.5% across indication groups.
Conclusions:
- Coronary artery reoperations provide significant clinical improvement and long-term survival comparable to primary revascularization.
- Systemic hypothermia with cold cardioplegia may reduce perioperative myocardial infarction risk.
- Graft patency and patient outcomes are favorable across different reoperation indications.
Abstract:
The incidence of coronary artery reoperations averaged 2.7% from 1967 through 1979. In a mean interval of 51 months between operations, three-vessel disease increased from 24% to 63%, and 31% of these 500 consecutive patients lost previously normal left ventricular function. Three angiographic indication groups were identified: (1) progressive coronary atherosclerosis, 247 (51%); (2) graft failure, 147 (29%); and (3) a combination of progressive coronary atherosclerosis and graft failure, 96 (19%). Angina recurred earlier in patient with graft failure, mean 17 months compared with a mean of 37 months for the other groups. Twenty (4%) operative deaths occurred. The series is divided into 387 patients operated upon under normothermic anoxic arrest and 113 with systemic hypothermia and cold cardioplegia. In the cardioplegia group, perioperative myocardial infarction was 2.7% in comparison with 7.8% for patients with anoxic arrest (p = 0.055). The number of grafts per patient increased from 1.0 to 1.9 and blood usage decreased from 11 units to 2.7 units. After a mean follow-up of 42 months, angina was relieved or improved in 86%. Recatheterization of 104 patients after a mean interval of 19 months showed a 79% vein graft patency rate and a 97% mammary artery graft patency rate. Grafting performed for graft failure (47) yielded an 85% patency rate. Actuarial 5 year survival was 87.4% for those with progressive atherosclerosis, 89.4% for patients with graft failure, and 91.5% for the combined indication group. Clinical improvement, graft patency, and long-term survival are nearly equal among the indication groups. Palliation derived from these reoperations approaches that achieved after primary revascularization.