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Third-time coronary artery bypass grafting: midterm results
W H Merrill1, C C Elkins, J R Stewart
1Department of Cardiac and Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
Insights
Third coronary artery bypass surgery offers significant long-term symptom relief for patients with unstable angina. This complex procedure demonstrates low mortality and morbidity, improving patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Limited data exist on outcomes for patients undergoing repeat myocardial revascularization.
- Coronary artery bypass grafting (CABG) is a common procedure, but outcomes after multiple reoperations are less understood.
Purpose of the Study:
- To evaluate the safety and efficacy of a third myocardial revascularization procedure.
- To assess the short-term and long-term outcomes in patients undergoing their third CABG.
Main Methods:
- Retrospective review of 13 consecutive patients undergoing their third CABG for unstable angina.
- Analysis of perioperative data, including graft number, surgical approach, and complications.
- Follow-up assessment of long-term survival and symptom status.
Main Results:
- Hospital mortality was 7.7% (1/13), with the single death attributed to incomplete revascularization.
- Postoperative complications included intra-aortic balloon pump support in 3 patients and prolonged ventilation in 2.
- At a mean follow-up of 44 months, 12 survivors showed significant symptomatic improvement, with 9 experiencing no or mild angina.
Conclusions:
- Third myocardial revascularization is associated with low mortality and morbidity.
- The procedure offers the potential for long-lasting symptomatic improvement in carefully selected patients.
- Further research is warranted to optimize patient selection and surgical techniques for repeat CABG.
Abstract:
Minimal data are available regarding the results of patients who have undergone myocardial revascularization more than twice. The records of 13 consecutive patients who underwent a coronary artery bypass procedure for the third time were reviewed. The indication for operation was unstable angina in all patients. All patients were placed on cardiopulmonary bypass through a median sternotomy. The mean number of bypass grafts placed at the third operation was 1.9 (range, 1 to 3 grafts). A new internal mammary artery graft was placed in 6 patients (2 had prior internal mammary artery grafts). Hospital mortality was 7.7% (1/13). The single death was due to incomplete revascularization in a patient with poor distal vessels. Three patients required intraaortic balloon pump support postoperatively, and 2 patients had prolonged ventilatory insufficiency. There have been no late deaths. The 12 survivors have been followed up a mean of 44 months (range, 6 to 90 months). Four remain asymptomatic; 5 have mild angina easily controlled with medication. All except 1 are in improved condition compared with their preoperative status. We conclude that a third myocardial revascularization can be performed with low mortality and morbidity and with the expectation of long-lasting symptomatic improvement.
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