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Reoperation for recurrent coronary artery disease: results of 200 consecutive cases
Y Shimada1, A Dixit, G Fermanis
1Department of Cardiothoracic Surgery, St George Hospital, Kogarah, New South Wales, Australia. yasuyuki@ozemail.com.au
Insights
Redo coronary artery bypass grafting (CABG) can achieve mortality rates comparable to primary CABG with careful surgical techniques. This study found low morbidity and mortality in 200 redo CABG patients, demonstrating the safety of repeat procedures.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Coronary Artery Disease Management
Background:
- Reoperation for recurrent coronary artery disease presents increased surgical challenges compared to primary coronary artery bypass grafting.
- Careful surgical technique is crucial for mitigating the risks associated with redo coronary artery bypass grafting.
Purpose of the Study:
- To evaluate the outcomes of redo coronary artery bypass grafting.
- To compare the morbidity and mortality rates of redo coronary artery bypass grafting with primary procedures.
Main Methods:
- Retrospective analysis of the first 200 patients undergoing redo coronary bypass grafting.
- Data collection on in-hospital deaths, complications (sternal infection, stroke, bleeding), and need for prolonged mechanical ventilation.
Main Results:
- The study included 200 redo coronary bypass grafting cases with a 2.5% in-hospital mortality rate.
- Low rates of complications were observed: 0.5% sternal infection, 1.5% stroke, 0.5% postoperative bleeding requiring reoperation, and 3% requiring prolonged mechanical ventilation.
- Urgency of surgery and preoperative ventricular impairment significantly impacted the need for major postoperative support.
Conclusions:
- The mortality rate for redo coronary artery bypass grafting in this series is comparable to reported rates for primary surgery.
- Careful surgical management can lead to favorable outcomes in patients requiring reoperation for coronary artery disease.
Background:
It is well known that reoperation for recurrent coronary artery disease is more difficult than primary coronary artery bypass grafting. However, it is possible to reduce the morbidity and mortality of reoperation to the same level as the initial procedure with careful surgical technique.
Methods:
A retrospective study of the first 200 patients who underwent redo coronary bypass grafting was undertaken.
Results:
In the first 200 cases of redo coronary bypass grafting at St George Hospital, Sydney (August 1986-January 1995), there were five in-hospital deaths (2.5%). There was one case of sternal infection (0.5%), which required surgical debridement, three cases of stroke (1.5%), one case of postoperative bleeding (0.5%), which required a return to theatre and six cases (3%) required mechanical ventilation for more than 24 h. The need for major postoperative support (such as intra-aortic balloon pumping/adrenaline infusion) was significantly affected by the degree of urgency and the degree of pre-operative ventricular impairment.
Conclusions:
The mortality rate of redo coronary artery bypass grafting in this series is similar to that of primary surgery described in other reports.