Third-time coronary artery revascularization.
Eighteen patients underwent a third coronary artery revascularization (rere-CABG) between 1983 and 1991. The factors necessitating rere-CABG were graft failure in 83% of the patients and progression of native coronary atherosclerosis in 17%. Mean interval between the second and third operation was 49.1 months. Median sternotomy and cardiopulmonary bypass (CPB) were used in 12 patients, a left thoracotomy approach was used in 6 (with CPB in 3 patients and without CPB in 3). The mean revascularization rate was 2.2 (grafts/patient). The internal thoracic artery was employed in 12 patients and the right gastroepiploic artery was used in one. Operative mortality was 11.1% (2 deaths). Non-fatal perioperative myocardial infarction, reexploration for bleeding, and respiratory failure occurred in one patient each. There were no other serious complications. Long-term follow-up was obtained in 15 of the 16 survivors. Four patients had recurrence of angina pectoris, and one late death due to myocardial infarction occurred. The myocardial event-free rate was 75% at 3.4 years. This experience indicates that a third coronary revascularization can be justified: operative approach and choice of graft material have to be individualized, but adequate long-term results can be obtained.
Watanabe
G
G
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Haverich
A
A
Speier
R
R
D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D005860:Germany, West / Q000453:epidemiology; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D012307:Risk Factors