title: Coronary reoperations: recurrence of angina and clinical outcome with and without cardiopulmonary bypass.
abstract: BACKGROUND
  We compared our experience of minimal tissue dissection and target vessel revascularization without cardiopulmonary bypass (CPB) with the standard procedure of total dissection of the heart and complete revascularization with CPB in patients who had elective reoperative coronary artery bypass grafting (redo-CABG).
  
  
  METHODS
  We analyzed recurrence of angina and clinical outcome in 118 patients who had elective redo-CABG between January 1995 and April 2002. Seventy-four patients had redo-CABG with CPB, and 44 patients had redo-CABG without CPB.
  
  
  RESULTS
  Perioperative outcome was comparable with regard to morbidity and mortality rates. At follow-up, the mean Canadian Cardiovascular Society score was 1.3 +/- 0.6 in patients who had redo-CABG with CPB and 1.7 +/- 0.8 in patients who had redo-CABG without CPB (p = 0.02). At follow-up, patients who had redo-CABG without CPB had a higher rate of recurrence of angina (log rank = 0.001) and higher use of nitrates (p = 0.015). Target vessel revascularization was an independent predictor of recurrence of angina in younger patients (< 75 years; p = 0.012) but not in the elderly (> or = 75 years; p = 0.142).
  
  
  CONCLUSIONS
  In elective redo-CABG patients, minimal tissue dissection and target vessel revascularization without cardiopulmonary bypass did not add significant benefit with regard to perioperative morbidity and mortality. The unsatisfactory relief of symptoms does not seem to justify target vessel revascularization by a less invasive approach. Therefore, this technique should be offered exclusively to patients at high risk with complete revascularization using CPB, such as the elderly.
authors.affiliation: Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Daniel
authors.initials: D
authors.lastname: Zimpfer
authors.forename: Juliane
authors.initials: J
authors.lastname: Kilo
authors.forename: Roman
authors.initials: R
authors.lastname: Gottardi
authors.forename: Daniela
authors.initials: D
authors.lastname: Dunkler
authors.forename: Ernst
authors.initials: E
authors.lastname: Wolner
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D002544:Cerebral Infarction / Q000401:mortality; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009203:Myocardial Infarction / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome