Coronary by-pass reoperations without cardiopulmonary by-pass: the Israeli experience.
OBJECTIVE
To evaluate results of coronary artery by-pass grafting (CABG) reoperations without cardiopulmonary by-pass (CPB).


METHODS
Thirty-two patients underwent CABG reoperation with CPB between December 1991 and December 1993. There were 29 (91%) males, and 3 (9%) females. Mean age was 62 +/- 7 years. Five (16%) were operated on emergently, two (6%) of them during cardiogenic shock. Three (9%) were referred for operation up to two weeks following acute MI. Six (19%) had preoperative EF < 35%. Significant associated systemic diseases included previous CVA in two patients (6%), calcified aorta in two (6%), peripheral vascular disease in six (19%), renal failure in one (3%), and severe COPD in one (3%). Mean number of grafts/pt was 1.5 (range 1-3), and IMA was used in 26 (81%) of patients. Only nine patients (28%) received a graft to a circumflex marginal artery, six (66%) of whom were operated on through left thoracotomy.


RESULTS
Only two patients (6%) had low output syndrome postoperatively; one was supported with catecholamines, and the other with intraaortic balloon pump. Hospital stay was 6.1 +/- 1.5 days (mean +/- SD). Early unfavorable outcome included operative death in one patient (3.1%), non-fatal MI in two (6%), and sternal infection in one (3%). Follow-up (10 +/- 5 months, mean +/- SD) showed two late deaths (one cardiac, and one carcinoma), one (3%) non-fatal MI, and return of angina in three (9%) patients.


CONCLUSIONS
CABG reoperations without CPB should be considered, particularly for revascularization of the LAD and RCA systems. Left thoracotomy is optional for patients with disease confined to circumflex and LAD systems.
Moshkovitz
Y
Y
Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Sternik
L
L
Mohr
R
R
D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors