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[Reoperations of myocardial revascularization]
J L Vallejo1, J M González-Santos, J S Guisasola
1Servicio de Cirugía Cardiovascular, Hospital General Universitario Gregorio Marañón, Madrid.
Insights
Re-do coronary artery bypass grafting is a viable option for myocardial ischemia despite increased risks compared to the initial surgery. Long-term outcomes are acceptable, though mortality rates remain higher.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Interventional Cardiology
Context:
- Coronary artery bypass grafting (CABG) is a standard treatment for ischemic heart disease.
- Re-operation for CABG is sometimes necessary.
- This study analyzes outcomes of repeat CABG procedures.
Purpose:
- To present the authors' experience with re-do coronary artery bypass grafting.
- To evaluate the efficacy and safety of repeat CABG in patients with ischemic heart disease.
Summary:
- A retrospective analysis of 128 patients undergoing re-do CABG between 1978 and 1996.
- Predominant clinical presentations included unstable angina (76.3%), myocardial infarction (48%), and congestive heart failure (17%).
- Hospital mortality was 10.9%, with perioperative myocardial infarction being the primary cause.
Impact:
- Re-do CABG is effective for myocardial ischemia, though associated with higher mortality and morbidity than primary surgery.
- Improved techniques and interventional cardiology may contribute to stable patient numbers over time.
- Long-term results are satisfactory, but carry a higher mortality risk.
Unlabelled:
Coronary by-pass grafting is a well established procedure for ameliorating ischemic coronary disease. From time to time it is necessary to re-operate these patients. The objective of our paper is to present our experience in this field. Retrospective analysis of 128 patients operated on between February 1978 and November 1996, has been analyzed. The mean age was 57.4 +/- 0.7 years. 77.2 +/- 5 months elapsed between operations. Stable angina (20.4%) or unstable angina (76.3%), myocardial infarction (48%) and congestive heart failure (17%) were the predominant clinical manifestations.
Results:
Hospital mortality was 10.9% (14 patients) and in the follow-up there were 16 deaths (14%). Perioperative myocardial infarction was the main cause of in-hospital mortality. In the follow-up there were 4 deaths due to myocardial infarction and another 4 patients died from neoplasms. Perioperative myocardial infarction was present in 9.3% (12 patients)
In Conclusion:
a) Re-do coronary by-pass grafting is still a good procedure for solving myocardial ischemia in spite of a higher mortality and morbidity than in the original operation. b) There is no progression in the number of patients according to our experience, probably due to better techniques and the frequent actions by an intervention cardiologist. c) The long-term results are good enough, but with a higher mortality.