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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.
Insights
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.
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.
Abstract:
Eighteen patients underwent a third coronary artery revascularization (rere-CABG) between 1983 and 1991. The factors necessitating rere-CABG were graft failure in 83% of the patients and progression of native coronary atherosclerosis in 17%. Mean interval between the second and third operation was 49.1 months. Median sternotomy and cardiopulmonary bypass (CPB) were used in 12 patients, a left thoracotomy approach was used in 6 (with CPB in 3 patients and without CPB in 3). The mean revascularization rate was 2.2 (grafts/patient). The internal thoracic artery was employed in 12 patients and the right gastroepiploic artery was used in one. Operative mortality was 11.1% (2 deaths). Non-fatal perioperative myocardial infarction, reexploration for bleeding, and respiratory failure occurred in one patient each. There were no other serious complications. Long-term follow-up was obtained in 15 of the 16 survivors. Four patients had recurrence of angina pectoris, and one late death due to myocardial infarction occurred. The myocardial event-free rate was 75% at 3.4 years. This experience indicates that a third coronary revascularization can be justified: operative approach and choice of graft material have to be individualized, but adequate long-term results can be obtained.