title: Contemporary results show repeat coronary artery bypass grafting remains a risk factor for operative mortality.
abstract: BACKGROUND
  Reoperative coronary artery bypass grafting (redo CABG) shows improving outcomes, but with varying degrees of improvement. We assessed contemporary outcomes after redo CABG to determine if redo status is still a risk factor for early postoperative complications and midterm survival.
  
  
  METHODS
  Isolated CABG procedures (June 1, 2001 to May 31, 2008) within the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database were included. Redo status as a predictor for early outcomes was assessed with logistic regression analysis. Midterm survival was determined from the National Death Index. Effect of redo status on midterm survival was assessed using a Cox proportional hazards model.
  
  
  RESULTS
  Inclusion criteria were met by 13,436 patients, and 458 (3.4%) underwent redo CABG. Operative mortality was 4.8% for redo CABG and 1.8% for first-time CABG (p < 0.001). After adjustment, redo status remained a predictor for operative mortality (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.3 to 3.6), myocardial infarction (OR, 2.8; 95% CI, 1.6 to 6.0), and prolonged ventilation (OR, 1.5; 95% CI, 1.1 to 2.0). Unadjusted survival was lower for the redo CABG group vs the first-time CABG group at up to 6 years (p = 0.01, log-rank test. After adjusting for differences in patient variables, redo status was not a predictor of midterm survival (OR, 1.03; 95% CI, 0.78 to 1.35; p = 0.85).
  
  
  CONCLUSIONS
  Early postoperative outcomes of redo CABG are encouraging. Midterm survival is excellent; however, redo remains a significant risk factor for operative mortality in contemporary practice.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia. cheng-hon.yap@mh.org.au
authors.forename: Cheng-Hon
authors.initials: CH
authors.lastname: Yap
authors.forename: Luigi
authors.initials: L
authors.lastname: Sposato
authors.forename: Enoch
authors.initials: E
authors.lastname: Akowuah
authors.forename: Sanjay
authors.initials: S
authors.lastname: Theodore
authors.forename: Diem T
authors.initials: DT
authors.lastname: Dinh
authors.forename: Gilbert C
authors.initials: GC
authors.lastname: Shardey
authors.forename: Peter D
authors.initials: PD
authors.lastname: Skillington
authors.forename: James
authors.initials: J
authors.lastname: Tatoulis
authors.forename: Michael
authors.initials: M
authors.lastname: Yii
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
authors.forename: Morteza
authors.initials: M
authors.lastname: Mohajeri
authors.forename: Adrian
authors.initials: A
authors.lastname: Pick
authors.forename: Siven
authors.initials: S
authors.lastname: Seevanayagam
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data*; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000401:mortality* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors
chemical_list: D003404:Creatinine