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Coronary by-pass reoperations without cardiopulmonary by-pass: the Israeli experience
Y Moshkovitz1, L Sternik, R Mohr
1Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Coronary artery by-pass grafting (CABG) reoperations without cardiopulmonary by-pass (CPB) show promising results, particularly for revascularizing the left anterior descending and right coronary artery systems. This approach offers a viable option for select patients needing repeat cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Reoperation
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery by-pass grafting (CABG) reoperations present unique challenges compared to primary procedures.
- Evaluating outcomes of CABG reoperations performed without cardiopulmonary by-pass (CPB) is crucial for refining surgical techniques.
Purpose of the Study:
- To assess the efficacy and safety of CABG reoperations conducted without cardiopulmonary by-pass (CPB).
- To identify patient subgroups that may benefit most from this approach.
Main Methods:
- A retrospective analysis of 32 patients undergoing CABG reoperation without CPB between December 1991 and December 1993.
- Data collected included patient demographics, preoperative conditions, surgical details (e.g., graft types, use of internal mammary artery), and perioperative outcomes.
Main Results:
- The study involved 32 patients (91% male, mean age 62 years) with various comorbidities and prior cardiac events.
- Early outcomes included a low incidence of low output syndrome (6%), operative death (3.1%), non-fatal myocardial infarction (MI) (6%), and sternal infection (3%).
- Follow-up at 10 months revealed low rates of late mortality (6%) and non-fatal MI (3%), with 9% experiencing angina recurrence.
Conclusions:
- CABG reoperations without CPB are a feasible and safe option, particularly for revascularizing the left anterior descending (LAD) and right coronary artery (RCA) systems.
- Left thoracotomy can be a suitable approach for patients with disease limited to the circumflex and LAD systems.
Objectives:
To evaluate results of coronary artery by-pass grafting (CABG) reoperations without cardiopulmonary by-pass (CPB).
Materials And Methods:
Thirty-two patients underwent CABG reoperation with CPB between December 1991 and December 1993. There were 29 (91%) males, and 3 (9%) females. Mean age was 62 +/- 7 years. Five (16%) were operated on emergently, two (6%) of them during cardiogenic shock. Three (9%) were referred for operation up to two weeks following acute MI. Six (19%) had preoperative EF < 35%. Significant associated systemic diseases included previous CVA in two patients (6%), calcified aorta in two (6%), peripheral vascular disease in six (19%), renal failure in one (3%), and severe COPD in one (3%). Mean number of grafts/pt was 1.5 (range 1-3), and IMA was used in 26 (81%) of patients. Only nine patients (28%) received a graft to a circumflex marginal artery, six (66%) of whom were operated on through left thoracotomy.
Results:
Only two patients (6%) had low output syndrome postoperatively; one was supported with catecholamines, and the other with intraaortic balloon pump. Hospital stay was 6.1 +/- 1.5 days (mean +/- SD). Early unfavorable outcome included operative death in one patient (3.1%), non-fatal MI in two (6%), and sternal infection in one (3%). Follow-up (10 +/- 5 months, mean +/- SD) showed two late deaths (one cardiac, and one carcinoma), one (3%) non-fatal MI, and return of angina in three (9%) patients.
Conclusions:
CABG reoperations without CPB should be considered, particularly for revascularization of the LAD and RCA systems. Left thoracotomy is optional for patients with disease confined to circumflex and LAD systems.