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Third-time coronary artery revascularization

G Watanabe1, A Haverich, R Speier

  • 1Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.

The Thoracic and Cardiovascular Surgeon
|June 1, 1993
PubMed
Summary
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Third coronary artery bypass grafting (CABG) is a viable option for select patients, primarily those with graft failure or atherosclerosis progression. This study shows acceptable long-term outcomes are achievable with individualized surgical approaches.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Repeated coronary artery revascularization procedures are complex and carry significant risks.
  • Graft failure and progression of native coronary artery disease are primary indications for repeat bypass surgery.

Purpose of the Study:

  • To evaluate the safety and efficacy of a third coronary artery revascularization (rere-CABG).
  • To analyze factors influencing outcomes and identify patient subgroups who may benefit from this procedure.

Main Methods:

  • Retrospective analysis of 18 patients undergoing rere-CABG between 1983 and 1991.
  • Surgical approaches included median sternotomy and left thoracotomy, with varying use of cardiopulmonary bypass (CPB).
  • Graft materials included internal thoracic artery and right gastroepiploic artery.

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Main Results:

  • Operative mortality was 11.1% (2 deaths).
  • Common complications included non-fatal myocardial infarction, reexploration for bleeding, and respiratory failure.
  • Long-term follow-up (mean 3.4 years) showed a myocardial event-free rate of 75%.

Conclusions:

  • Third coronary artery revascularization is justifiable in carefully selected patients.
  • Individualized operative strategies and graft material selection are crucial for successful outcomes.
  • Adequate long-term results can be achieved, suggesting rere-CABG can be a beneficial option.