Document Detail


The changing pattern of reoperative coronary surgery: trends in 1230 consecutive reoperations.
MedLine Citation:
PMID:  10884669     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We noted an increasing risk profile of patients undergoing reoperative coronary surgery. We evaluated the risk compared with primary procedures, our results over a 16-year span, and the predictors of hospital outcomes after redo surgery. METHODS: We analyzed 20,614 patients undergoing isolated coronary surgery at our institution from 1982 to 1997. Of these, 1230 (6.0%) were undergoing reoperation. Independent predictors of outcomes were identified by multivariable regression. RESULTS: The prevalence of reoperation peaked in 1994 at 8.2%. Patients undergoing reoperation were more likely to be male, to have left ventricular dysfunction and worse symptoms, and to require an urgent operation than patients undergoing a primary operation (P <.0001). Perioperative myocardial infarctions (3.7% vs 7.4%), low-output syndrome (9.0% vs 24.0%), and death (2.4% vs 6.8%) were more common in patients undergoing reoperation (all P <.0001). Over the years, the risk profile of patients undergoing reoperation increased. Age, left ventricular dysfunction, severity of symptoms, extent of coronary artery disease, left main stenosis, and requirement for urgent or emergency operations increased with time (P <.05). However, mortality, myocardial infarction, and low-output syndrome have remained constant. The independent predictors of mortality after reoperative surgery were increased age, greater Canadian Cardiovascular Society symptom class, earlier year of operation, and greater left ventricular dysfunction. After 1990, analysis of an expanded data set also identified peripheral vascular disease and failure to use retrograde cardioplegia as predictors of mortality. CONCLUSIONS: Improving results of reoperative surgery have been offset by an increasing patient risk profile. Meticulous operative technique and retrograde cardioplegia may permit good results in these high-risk patients.
Authors:
T M Yau; M A Borger; R D Weisel; J Ivanov
Related Documents :
6833659 - Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation...
19703119 - Thalamic infarct presenting as apparent life-threatening event in infants.
12430669 - A historical cohort study of the effect of lowering body iron through blood donation on...
8166059 - Prognostic value of dipyridamole technetium-99m sestamibi myocardial tomography in pati...
24565879 - Myocardial infarction in a young man due to coronary artery aneurysms after an undiagno...
12565079 - Prognostic value of exercise cardiac tomography performed late after percutaneous coron...
23917519 - Deficiency of cartilage oligomeric matrix protein causes dilated cardiomyopathy.
19952479 - A case of iron overload cardiomyopathy: beneficial effects of iron chelating agent and ...
22854359 - The use of troponin in general practice.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  120     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-09     Completed Date:  2000-08-09     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  156-63     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. terry.yau@utoronto.ca
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Coronary Artery Bypass / mortality,  statistics & numerical data*
Female
Hospital Mortality
Humans
Intraoperative Care
Male
Middle Aged
Reoperation / trends
Risk Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Pulmonary homograft: should it be used in the aortic position?
Next Document:  In vivo and in vitro study of radio-frequency application with a new long linear probe: implication ...