Document Detail


Reoperative coronary artery bypass grafting: analysis of early and late outcomes.
MedLine Citation:
PMID:  15620920     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The purpose of this study was to evaluate early and late results of reoperative coronary artery bypass grafting compared with those of first coronary artery bypass grafting. METHODS: From November 21, 1994, to December 31, 2001, 4,381 patients underwent isolated coronary revascularization: among these patients, 274 (6.3%) underwent a redo. Applying the propensity score, 239 redo patients (group R) were matched with 239 who underwent the first revascularization (group F). RESULTS: Early mortality was 2.1% (group F) and 4.2% (group R), not significantly different. Group R showed significantly higher creatine kinase myocardial band release, length of intensive care unit stay, and incidence of incomplete myocardial revascularization than group F. In group R, off-pump patients showed higher incidence of incomplete revascularization. Redo was a risk factor for abnormal (>19 IU/L) creatine kinase myocardial band release (odds ratio, 1.7; p = 0.0066) and incomplete myocardial revascularization (odds ratio, 2.4; p = 0.0060). Five-year clinical outcome was significantly worse in group R, except for freedom from redo or percutaneous transluminal coronary angioplasty. Redo was an independent variable for lower freedom from death of any cause, cardiac death, acute myocardial infarction, cardiac events, and any event. Patients with higher creatine kinase myocardial band release or incomplete myocardial revascularization showed lower freedom from cardiac-related events. Incidence of incomplete myocardial revascularization and creatine kinase myocardial band release were significantly higher in group R by both univariate and multivariate analysis. This could explain the worse late outcome of redo patients. CONCLUSIONS: Complete revascularization without damaging the heart, whichever technique is used, is the target of redo surgery, to achieve the same quality of results obtained in the first operation.
Authors:
Michele Di Mauro; Angela L Iacò; Marco Contini; Giovanni Teodori; Giuseppe Vitolla; Marco Pano; Gabriele Di Giammarco; Antonio M Calafiore
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  79     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2004-12-28     Completed Date:  2005-08-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  81-7     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac Surgery, G D'Annunzio University, Chieti, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cardiac Output, Low / epidemiology
Cohort Studies
Coronary Artery Bypass / statistics & numerical data*
Coronary Artery Bypass, Off-Pump / statistics & numerical data
Creatine Kinase / blood
Creatine Kinase, MB Form
Female
Follow-Up Studies
Humans
Isoenzymes / blood
Life Tables
Male
Middle Aged
Myocardial Infarction / blood,  mortality,  surgery
Myocardial Ischemia / blood,  mortality,  surgery*
Postoperative Complications / mortality
Proportional Hazards Models
Prospective Studies
Recurrence
Reoperation / statistics & numerical data
Stroke / mortality
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Isoenzymes; EC 2.7.3.2/Creatine Kinase; EC 2.7.3.2/Creatine Kinase, MB Form

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