title: Early and long term results of re-operation for coronary artery disease.
abstract: OBJECTIVE
  To define the incidence, possible causes, operative procedure, and early and medium term results of patients undergoing reoperation for coronary artery disease.
  
  
  METHODS
  A retrospective analysis of patients undergoing reoperation in one hospital during a 10 year period.
  
  
  METHODS
  A regional cardiothoracic centre.
  
  
  METHODS
  115 patients had reoperation for recurrent angina, 1-17 years (mean (SD) 7.4 (3.9)) after primary revascularisation.
  
  
  METHODS
  They received 279 grafts (2.4 grafts per patient); 58% of the grafts were anasatomosed to previously grafted vessels. The internal mammary artery was used in 87% of patients who required grafts to the left anterior descending coronary artery.
  
  
  RESULTS
  Reoperation accounted for 8.3% of the total number of patients who underwent coronary bypass grafting. Graft failure alone or in combination with other factors was judged to be the cause of recurrence of symptoms in 87%. 42% of patients had two or more coronary risk factors. The early mortality was 5.2% and the actuarial survival at five and 10 years was 90.4% and 88.4% respectively. 85% of the survivors had initial complete relief of angina and 14% had partial improvement. Freedom from recurrent symptoms at five and 10 years was 66.6% and 34.6% respectively.
  
  
  CONCLUSIONS
  Vein graft failure either alone or in combination with progression of native coronary disease is the main cause for symptomatic deterioration after bypass grafting. Reoperation can be performed with slightly increased risk and can give good early and medium term results.
authors.affiliation: Cardiac Surgical Unit, Harefield Hospital, Middlesex.
authors.forename: E S
authors.initials: ES
authors.lastname: Akl
authors.forename: E
authors.initials: E
authors.lastname: Ozdogan
authors.forename: S K
authors.initials: SK
authors.lastname: Ohri
authors.forename: M
authors.initials: M
authors.lastname: Barbir
authors.lastname: Kiti-Chei
authors.forename: J A
authors.initials: JA
authors.lastname: Gaer
authors.forename: A G
authors.initials: AG
authors.lastname: Mitchell
authors.forename: M H
authors.initials: MH
authors.lastname: Yacoub
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000601:surgery; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality*; D011379:Prognosis; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors