Outcome after redo coronary artery bypass grafting in patients with ischaemic cardiomyopathy and viable myocardium.
BACKGROUND
Repeat coronary artery bypass grafting (redo-CABG) in patients with ischaemic cardiomyopathy is associated with high perioperative risk and worse long-term outcome compared with patients undergoing their first CABG.


OBJECTIVE
To assess whether patients with viable myocardium undergoing redo-CABG have a better outcome.


METHODS
18 patients with ischaemic cardiomyopathy underwent redo-CABG and 34 underwent their first CABG; all had substantial viability (> or =25% of the left ventricle) on dobutamine stress echocardiography (DSE). Left ventricular ejection fraction (LVEF) and heart failure symptoms were assessed before and 9-12 months after revascularisation. Cardiac event rate was assessed during the follow-up period (median 4 years, 25-75th centile 2.8-4.9 years).


RESULTS
The extent of viable myocardium on DSE was comparable in the two groups (11.3 (3.9) segments in patients who underwent redo-CABG v 12.8 (3.0) in patients who underwent their first CABG; p = NS). LVEF improved from 32% (9%) to 39% (12%); p = 0.01, in patients who underwent redo-CABG and from 30% (7%) to 36% (7%); p<0.01, in those who underwent their first CABG; New York Heart Association class improved from 2.5 (1.1) to 1.9 (0.8); p = 0.03, and from 2.7 (1.0) to 1.8 (0.70); p<0.01, respectively. In patients who underwent redo-CABG, the perioperative mortality was 0, post-surgery inotropic support was needed in 11% of the patients and mid-term (4-year) survival was 100%, with a total event rate of 28%. All these variables were not statistically different from patients who underwent their first CABG (p = 0.50, 0.90, 0.08 and 0.81, respectively).


CONCLUSIONS
Patients with ischaemic cardiomyopathy and substantial viability undergoing redo-CABG benefit from revascularisation in terms of improvement in LVEF, heart failure symptoms, angina and mid-term prognosis.
Rizzello
V
V
Department of Cardiology, Thorax Center Room Ba 300, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Poldermans
D
D
Schinkel
A F L
AF
Biagini
E
E
Boersma
E
E
Elhendy
A
A
Sozzi
F B
FB
Palazzuoli
A
A
Maat
A
A
Crea
F
F
Bax
J J
JJ
D000368:Aged; D002316:Cardiotonic Agents; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D018450:Disease Progression; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009206:Myocardium / Q000473:pathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D002316:Cardiotonic Agents; D004280:Dobutamine