title: Evolving trends of reoperative coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database.
abstract: OBJECTIVE
  The present study evaluated the evolving trends and outcomes of patients undergoing isolated reoperative coronary artery bypass grafting at Society of Thoracic Surgeons Adult Cardiac Surgery Database-participating institutions.
  
  
  METHODS
  From 2000 to 2009, 72,431 patients underwent isolated reoperative coronary artery bypass grafting and 1,497,254 patients underwent isolated primary coronary artery bypass grafting at Society of Thoracic Surgeons-participating institutions. The demographics, operative characteristics, and risk-adjusted postoperative outcomes were assessed and compared during the study period.
  
  
  RESULTS
  As a percentage of overall coronary artery bypass grafting volume, reoperative coronary artery bypass grafting decreased from 6.0% (8820/137,267) in 2000 to 3.4% (5734/160,997) in 2009. The unadjusted operative mortality declined from 6.1% (542/8820) in 2000 to 4.6% (261/5734) in 2009 (P < .05). Patients now more frequently present with left main disease (35.1% vs 25.7%; P < .05), myocardial infarction (60.9% vs 55.9%; P < .001), and heart failure (18.4% vs 14.2%; P < .001). Patients also now present more frequently for urgent or emergent surgery (51.6% vs 39%; P < .001) and after previous percutaneous coronary intervention (51% vs 35%; P < .001). They also have a greater incidence of other comorbidities such as increased weight (88 vs 84 kg; P < .001), diabetes (42.5% vs 31.7%; P < .001), hypertension (90.9% vs 73.4%; P < .001), hypercholesterolemia (90.9% vs 73.4%; P < .001), renal failure (2.2% vs 0.7%; P < .001), and cerebrovascular disease (12.4% vs 8.5%; P < .001). Risk-adjusted mortality decreased from 6.0% to 4.6%, a relative risk reduction of 23.7% (P < .001). Risk-adjusted postoperative stroke decreased from 1.9% to 1.6% (P < .001).
  
  
  CONCLUSIONS
  Surgical coronary revascularization has evolved during the past decade, with reoperative coronary artery bypass grafting now uncommonly performed in contemporary practice. Despite treating patients with more complex coronary artery disease and greater medical comorbidities, significant improvements have occurred in operative morbidity and mortality in this challenging population.
authors: Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA.
authors: Ravi K
authors: RK
authors: Ghanta
authors: Tsuyoshi
authors: T
authors: Kaneko
authors: James S
authors: JS
authors: Gammie
authors: Shubin
authors: S
authors: Sheng
authors: Sary F
authors: SF
authors: Aranki
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology