再手術または初回冠動脈バイパス移植術のリスク調整後成績

Coronary artery bypass grafting (CABG) is a mainstay of therapy for advanced coronary artery disease. While the proportion of reoperative CABG has declined to roughly 3-7% of all CABG procedures, redo operations remain essential for patients with recurrent or refractory ischemia. Redo CABG involves greater technical complexity and risk, highlighting the need for risk-adjusted analyses.

We conducted a single-center retrospective review of all isolated CABG procedures from January 2009 to December 2023. After excluding emergent cases and missing data, 12,120 first-time CABG (designated: CABG) and 341 redo (designated: REDO-CABG) patients were analyzed. We used risk-score matching, inverse probability of treatment weighting (IPTW), and multivariable-adjusted approaches to assess in-hospital mortality, perioperative complications, and mortality and revascularization risks up to ten years of follow-up.

Crude in-hospital mortality was 1.0% in CABG versus 1.8% in REDO-CABG. After risk-score matching (258 pairs), in-hospital mortality did not differ statistically significantly between the two groups (1.2% vs. 1.9%; relative risk 1.68 (95%CI:0.40-7.10). Major perioperative complications, including stroke, myocardial infarction, hemofiltration, and extracorporeal membrane oxygenation use, were similar. However, the need for cardiopulmonary resuscitation tended to be higher in REDO-CABG, and repeat revascularization up to ten years was significantly greater in REDO-CABG. Both groups demonstrated comparable survival up to ten years of follow-up. Sensitivity analysis using the IPTW approach resulted in in-hospital mortality rates of 1.0% (CABG) and 0.8% (REDO-CABG), with a relative risk of 0.75 (95%CI:0.60-0.94).

In this risk-adjusted analysis, redo-CABG achieved similar in-hospital mortality and 10-year survival compared to CABG.