title: Changing pattern of reoperative coronary artery bypass grafting: a 20-year study.
abstract: BACKGROUND
  Fewer patients are undergoing reoperative coronary artery bypass grafting (CABG). We investigated the prevalence of redo vs primary CABG and previous percutaneous coronary intervention (PCI), changing trends in preoperative risk profiles, and independent predictors of operative death.
  
  
  METHODS
  Data on demographic characteristics, preoperative risk factors, and hospital outcomes were collected prospectively for patients undergoing isolated reoperative CABG from January 1, 1990, to December 31, 2009. To examine the effect of time on the prevalence of redo CABG cases and previous PCI, we divided patients into four groups: 1990 through 1994, 470; 1995 through 1999, 415; 2000 through 2004, 240; and 2005 through 2009, 79. To examine risk profiles and outcomes, we created two groups: 1990 through 1999, 885; 2000 through 2009, 319.
  
  
  RESULTS
  Redo CABG decreased from 7.2% (1990 through 1994) to 2.2% (2005 through 2009). PCI before redo CABG significantly increased from 14.5% (1990 through 1994) to 26.6% (2005 through 2009). Patients with diabetes, dyslipidemia, hypertension, peripheral vascular disease, and left main disease increased. In-hospital mortality did not change significantly, but postoperative low cardiac output syndrome dropped. Age (odds ratio [OR], 1.04), peripheral vascular disease (OR, 2), congestive heart failure (OR, 5.8), and preoperative shock (OR. 9.7) independently predicted higher operative mortality.
  
  
  CONCLUSIONS
  Reoperative CABG has significantly decreased. The increased prevalence of PCI before redo CABG is one of the reasons. Despite an increasing risk profile, hospital outcomes have remained largely the same. Preoperative shock and congestive heart failure are the most important predictors of operative mortality.
authors: Peter Munk Cardiac Centre, Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
authors: Konstantinos
authors: K
authors: Spiliotopoulos
authors: Manjula
authors: M
authors: Maganti
authors: Stephanie
authors: S
authors: Brister
authors: Vivek
authors: V
authors: Rao
mesh_terms: D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality / Q000639:trends; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D006769:Hospitals, General; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009864:Ontario; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D015995:Prevalence; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome