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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 250-259, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NW Salomon, US Page, JC Bigelow, AH Krause, JE Okies and MT Metzdorff
During an 18-year period a consecutive series of 6591 patients underwent
primary coronary bypass grafting and 508 patients underwent reoperative
bypass. The mean patient age for the reoperative group was identical to
that of the primary group, 59.8 years, but the mean age at initial
operation for the reoperative group was 55.2 years. Mammary grafts were
done at initial operation in 59% of patients who have had one operation
versus only 46% of patients who subsequently required reoperation (p less
than 0.001). The overall operative mortality rate was 2.0% (134/6591) for
primary coronary bypass versus 6.9% (35/508) for reoperations (p less than
0.001). Patients with a reoperative interval of 1 to 10 years had a 6.0%
(18/312) mortality rate, compared with 17.6% (13/74) for those in whom the
interval between operations was greater than 10 years (p less than 0.01).
Ventricular arrhythmias, excessive bleeding, prolonged ventilatory support,
intraaortic balloon pump insertion (all p less than 0.05), and
perioperative myocardial infarction (p less than 0.001) were all more
prevalent after reoperations. Including perioperative mortality, the
actuarial survival rate at 5 years was 80% for reoperations versus 90% for
primary operations. The corresponding figures at 10 years were 65% and 75%.
The probability of undergoing reoperation within 5 and 10 years was 0.034
+/- 0.003 and 0.055 +/- 0.005, respectively. Ten years postoperatively, 36%
of patients having the initial operation had recurrent angina whereas 58%
of the reoperative group had significant recurrent angina. Ten years after
reoperation, 30% of operative survivors were free of heart-related
morbidity and mortality compared with 50% of patients having a primary
operation. Univariate analysis of factors increasing the probability of
reoperation include the absence of a mammary graft and younger age at
operation. Patients undergoing a second bypass operation represent a
substantially higher risk subgroup than patients undergoing initial
operation in terms of perioperative morbidity, mortality, decreased
long-term survival, and decreased relief of recurrent cardiac morbidity.
ARTICLES
Reoperative coronary surgery. Comparative analysis of 6591 patients undergoing primary bypass and 508 patients undergoing reoperative coronary artery bypass
Division of Cardiovascular and Thoracic Surgery, Good Samaritan Hospital and Medical Center, Portland, Ore.
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