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[Coronary artery reoperation]
1Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo.
Insights
Coronary artery reoperation carries significant risks, with graft failure and disease progression being primary drivers. Utilizing arterial grafts, such as internal thoracic artery (ITA) and gastroepiploic artery (GEA), is crucial for achieving high graft patency and reducing reoperation rates.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Context:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease (CAD).
- Reoperation for CABG is less frequent but necessary in certain patient populations.
- Understanding the outcomes and challenges of coronary artery reoperation is vital for improving patient care.
Purpose:
- To analyze the outcomes of coronary artery reoperation in a cohort of 51 patients.
- To identify the causes and timing of reoperation after initial CABG.
- To evaluate the patency rates of various graft types used during reoperation.
Summary:
- This study reviewed 51 coronary artery reoperations over 9 years, with graft failure and native CAD progression as main indications.
- Early and late reoperations were analyzed, with a mean interval of 6 years between procedures.
- Arterial grafts (ITA, GEA) demonstrated superior patency rates (100% and 97%) compared to vein grafts (SV, 87%).
Impact:
- Coronary artery reoperation is associated with a high risk, necessitating careful patient selection and surgical technique.
- The use of arterial grafts significantly improves long-term graft patency and may reduce the need for future reoperations.
- Findings emphasize the importance of arterial conduits in achieving durable revascularization in patients requiring repeat CABG.
Abstract:
Coronary artery reoperation has been performed in 51 patients (4%) including 5 second reoperations among 1,245 CABGs during past 9 years. There were 40 males and 11 females with a mean age of 58 year old ranging from 19 to 75 year old. Extent of coronary artery disease were; single vessel disease in 2 patients, double vessel disease in 18 patients, triple vessel disease in 22 patients and left main disease in 9 patients. Preoperative ejection fraction ranged from 0.24 to 0.69 (mean 0.48) and 21 patients (41%) showed unstable angina. Interval between primary CABG and reoperation ranged from 1 month to 20 years with a mean of 6 years. There were two groups which had early reoperation at the mean of 6 months (14 patients) and late reoperation at the mean of 9 years (37 patients) after primary CABG. Causes of reoperation varied from graft failure (29 patients), progression of native CAD (2 patients), both of them (19 patients), and incomplete revascularization (1 patient). There were 32 patients who had patent old graft at the time of reoperation. Re-entry approaches used were midsternal in 41 patients and left thoracotomy in 10 patients. The ITA, GEA, IEA and SV grafts were used in 30, 38, 5 and 28 patients, respectively. There were 4 patients who underwent CABG without cardiopulmonary bypass. The mean number of bypass was 2.1 and the mean duration of aortic crossclamp and cardiopulmonary bypass were 63 minutes and 114 minutes, respectively. As a result, there were 4 early and 1 late death. Postoperative angiography revealed that patency rate of ITA, GEA, IEA and SV grafts were 100% (22/22), 97% (30/31), 75% (3/4) and 87% (20/23), respectively. In conclusion, risk of coronary artery reoperation is still high and use of arterial graft is important to obtain high patency rate and low reoperation rate.