Document Detail


The impact of a short interval ( < or = 1 year) between primary and reoperative coronary artery bypass grafting procedures.
MedLine Citation:
PMID:  9013014     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Reoperative (redo) coronary artery bypass grafting is an efficient treatment for patients with progressive coronary artery disease and those with conduit failure. Previous studies have demonstrated that a short time interval between primary and redo coronary artery bypass grafting is associated with a significantly higher mortality rate. In the present report this particular group have been specifically evaluated. Between 1 January 1990 and 1 October 1994, 383 consecutive patients underwent redo coronary artery bypass grafting. Thirty-three patients (8.6%) were operated on at < or = 1 year (group 1) and 350 patients at > 1 year after the primary bypass (group II). The main indications for redo in group I were graft failure (58%), incomplete revascularization (39%) and progress of disease (3%); respective values in group II were 26% 15%, and 23%. In addition, 36% of patients in group II had combinations of complications. Patient characteristics did not differ between groups, except a higher incidence of insulin-dependent diabetes in group I (P < 0.05). There was a higher incidence of left main stem stenosis of > 70% in group I (P < 0.05). Group I patients had a longer aortic cross-clamping time and needed thromboendarterectomy and patching of coronary vessels more often than did those in group II (P < 0.05). The internal mammary artery had been more frequently used at the primary coronary artery bypass grafting in group I (P < 0.01). The overall mortality rate was 8.9%; that in group I was 18% and in group II, 8% (P < 0.05). There was a higher incidence of non-fatal myocardial infarction and a need for prolonged ventilatory support (> 24 h) in group I. Other postoperative complications did not differ. Significant risk factors for mortality in group I were preoperative Canadian Cardiovascular Society class > or = 3, unstable angina, need for urgent operation and left ventricular ejection fraction < 40%, and > or = 70% left main stem stenosis. In group II, the risk factors were: unstable angina, urgent operation, left ventricular ejection fraction < 40%, internal mammary artery not used at primary coronary artery bypass grafting and the need for coronary thromboendarterectomy. The 3-year survival and cardiac event-free survival did not differ between the groups. This study has confirmed that early redo coronary artery bypass grafting (< or = 1 year from primary bypass) is associated with an increased operative risk.
Authors:
J T Christenson; F Simonet; M Schmuziger
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Cardiovascular surgery (London, England)     Volume:  4     ISSN:  0967-2109     ISO Abbreviation:  Cardiovasc Surg     Publication Date:  1996 Dec 
Date Detail:
Created Date:  1997-04-29     Completed Date:  1997-04-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9308765     Medline TA:  Cardiovasc Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  801-7     Citation Subset:  IM    
Affiliation:
Cardiovascular Surgery Unit, Hôpital de la Tour, Meyrin-Geneva, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Coronary Artery Bypass / mortality*
Coronary Disease / surgery*
Disease-Free Survival
Humans
Mammary Arteries / transplantation
Patient Selection
Reoperation
Risk
Survival Rate
Time Factors
Treatment Outcome

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


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