Related Experiment Videos
[Coronary reoperations: indications and results]
J P Mazzucotelli1, R Houel, P Le Besnerais
1Service de chirurgie thoracique et cardiovasculaire, hôpital Henri-Mondor, Créteil.
Insights
Coronary reoperations offer good long-term survival and functional outcomes. Key indications include bypass graft issues and coronary disease progression, with mortality predicted by advanced age and delayed reoperation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Context:
- Coronary reoperations are complex procedures performed in patients with previous coronary artery bypass grafting.
- Symptom recurrence after initial surgery necessitates careful evaluation for reoperation.
- This study analyzes outcomes from a significant cohort of coronary reoperations over an 18-year period.
Purpose:
- To assess the results and determine indications for coronary reoperations.
- To evaluate survival rates and functional outcomes following repeat coronary artery bypass grafting.
- To identify predictors of mortality in patients undergoing coronary reoperations.
Summary:
- 166 coronary reoperations were performed in 161 patients between 1972 and 1990.
- Early mortality was 7.8%, with age over 70 and delayed reoperation as significant risk factors.
- Actuarial 5- and 10-year survival rates were 85% and estimated 69% respectively, with good functional status maintained.
Impact:
- Coronary reoperations demonstrate favorable long-term survival and functional results.
- Findings provide evidence-based guidance for patient selection and timing of repeat coronary artery bypass grafting.
- The study contributes to understanding the long-term efficacy of surgical intervention for complex coronary artery disease.
Abstract:
The aim of this study was to assess the results of coronary reoperations and to determine the indications. Between January 1972 and December 1990, 166 coronary reoperations were performed in 161 patients (5 patients were operated three times). The interval between the first and second operation was 93 +/- 46 months. The interval between recurrence of symptoms and reoperation was 27 +/- 40 months. Recurrence of symptoms was related to isolated problems with the bypass grafts in 23% of cases, to an aggravation of the coronary disease without problems with the bypass grafts in 17% of cases and to an association of the two conditions in 60% of cases. Mortality in the first 30 postoperative days was 7.8% (13/161). The predictive factors of mortality were age over 70 years and an interval between recurrence of symptoms and reoperation of over 12 months. The causes of death were myocardial infarction (n = 5), left ventricular failure (n = 4), sudden death (n = 3), and arrhythmias (n = 1). The average follow-up period of survivors (n = 134) was 40 +/- 32 months. Four patients have been transplanted. Seven patients died secondarily. The cause of death was cardiac in 4 cases and non-cardiac in 3 cases. The actuarial 5 year and 10 year survival rates were 85 +/- 3%. Actuarial absence of myocardial infarction, angina, Class III-IV cardiac failure and transplantation was 87 +/- 4% at 5 years and 69 +/- 10% at 10 years. These figures show that coronary reoperation gives good functional results and long-term survival.(ABSTRACT TRUNCATED AT 250 WORDS)