[Seventy coronary reoperations: indication and results].
Seventy consecutive patients undergoing reoperative coronary artery bypass grafting (re-CABG) were reviewed to determine operative and late results, and indications of re-CABG. There was no operative death (within 30 days after re-CABG) but 3 (4.3%) hospital deaths in patients with emergency re-CABG. Although graft patency rate was acceptable (92.5%), the rate of complete revascularization was only 70%. Including non-cardiac death, the actuarial survival rate at 8 years was 88.2%, and event free rate including all deaths, the third time CABG, PTCA and myocardial infarction was 78.4% at 8 years. At re-CABG, no old arterial grafts and only 4.7% (2/43) of the old saphenous vein grafts to the left anterior descending artery (LAD) were patent without stenosis. Success rate of PTCA was 90.9% in the saphenous vein graft and 95.2% in the internal thoracic artery graft. Restenosis rate was significantly higher in the saphenous vein graft (55%) than the arterial graft (10%) (p < 0.001), and restenosis rate of repeat PTCA to the saphenous vein graft was 100%. In conclusion, re-CABG should be mainly indicated to the patients with persistent symptom and diseased grafts to the LAD, and PTCA to the old saphenous vein graft should be limited to once to avoid acute deterioration requiring emergency re-CABG.
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
H
H
Nishida
H
H
Ishitoya
S
S
Nemoto
H
H
Sakahashi
J
J
Hirota
T
T
Koyanagi
M
M
Kitamura
M
M
Endo
H
H
Koyanagi
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015996:Survival Rate; D013997:Time Factors; D014654:Vascular Patency