A 20-year experience in coronary artery reoperation.
We divided 2518 patients who underwent isolated coronary artery reoperation into four cohorts according to time. There were 436 patients reoperated on from 1967-1978, 439 in 1979-1981, 625 in 1982-1984, and 1018 in 1985-1987. The interval between operative procedures has lengthened from 50 months in the first cohort to 101 months in the most recent series. A review of angiographic indications reveals that vein graft atherosclerosis is the leading indication for coronary artery reoperation. Despite a changing population of reoperative surgical candidates in terms of diffuse coronary atherosclerosis and interim deterioration of left ventricular function, operative mortality has not increased. In the 1985-1987 cohort, hospital mortality was 2.7%. The perioperative myocardial infarction rate (new Q waves) of 4.0% in the most recent cohort shows a significant trend downward (P = 0.007), ascribed to better myocardial protection. The 5.4% return to the operating room for postoperative haemorrhage is significantly higher than the rate of bleeding after first surgery, but it has not changed in the past decade. Blood conservation has resulted in average blood usage of approximately two units per patient, but has risen to 2.7 units per patient in the most recent cohort. Other major morbidity is not appreciably different from that of the first operation. Internal thoracic artery patency in a largely symptomatic postreoperative population was 94% (241/256). Vein graft patency in the same time frame was 67% (726/1080). Approximately 50% of patients were angina-free 10 years postoperatively, which is below the percentage found after the first operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cleveland Clinic Foundation, Ohio 44195-5066.
D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D012086:Reoperation; D015996:Survival Rate; D014654:Vascular Patency