title: Third-time coronary artery bypass operations: surgical strategy and results.
abstract: BACKGROUND
  Increasingly, patients are returning for a second, third, and even fourth coronary artery bypass graft (CABG) procedure.
  
  
  METHODS
  This report reviews the in-hospital and long-term outcomes for 102 patients undergoing a third or fourth CABG at Emory University from December 1977 to April 1994.
  
  
  RESULTS
  The mean interval from the first to second CABG was 5.2 +/- 3.5 years and from the second to the third CABG 6.8 +/- 4.1 years. The mean age was 6 +/- 9 years, 91% were male, 33% had hypertension, 16% diabetes, 86% class III or IV angina (Canadian Cardiovascular Society), 4.4% congestive failure (New York Heart Association), and 73% three-vessel disease. The in hospital mortality rate was 9.8%, with a perioperative myocardial infarction rate of 8.8% and a stroke rate of 1.9%.
  
  
  CONCLUSIONS
  These perioperative mortality and myocardial infarction rates are several times higher than those reported for initial revascularizations or first-time redo CABG operations. However, the 5- and 10-year survival rates of 79% and 59%, respectively, and a myocardial infarction-free survival of 62% at 5 years, the benefits of a third-time CABG procedure are apparent for this high-risk group of patients.
authors.affiliation: Joseph P. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Craver
authors.forename: G T
authors.initials: GT
authors.lastname: Hodakowski
authors.forename: Y
authors.initials: Y
authors.lastname: Shen
authors.forename: W S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: K D
authors.initials: KD
authors.lastname: Accola
authors.forename: R A
authors.initials: RA
authors.lastname: Guyton
authors.forename: E L
authors.initials: EL
authors.lastname: Jones
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate