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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 605-612, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
BW Lytle, FD Loop, PC Taylor, M Goormastic, RW Stewart, R Novoa, P McCarthy and DM Cosgrove
Does coronary artery reoperation improve the survival of patients with
stenoses in saphenous vein bypass grafts to coronary arteries? To examine
this question, we retrospectively reviewed 1117 patients who had coronary
bypass grafting and then underwent a postoperative coronary angiogram that
showed a stenosis (> or = 20%) of at least one vein graft. Reoperation
within 1 month of the postoperative angiogram was performed for 394
patients (REOP group) whereas 723 patients (MED group) received initial
medical treatment (no reoperation or percutaneous transluminal coronary
angioplasty within 1 year). Compared with the MED group, patients in the
REOP group were older, more symptomatic, more likely to have left main
stenosis, and had fewer patent bypass grafts (all p < 0.001).
In-hospital mortality for the REOP group was 4.3%. Mean postangiogram
follow-up of the entire group was 73 months. On the basis of the interval
between the primary operation and the postoperative angiogram, patients
were designated as having early (< 5 years) or late (> or = 5 years)
saphenous vein graft stenosis. Univariate and multivariate analyses were
used to identify factors influencing the survival of these subgroups.
Reoperation was not identified as a variable improving the survival of
patients with early vein graft stenoses. For patients with late vein graft
stenoses, moderate or severe impairment of left ventricular function (p
< 0.0001), advanced age (p < 0.0001), triple-vessel or left main
stenosis (p = 0.0011), and stenosis in a vein graft to the left anterior
descending artery (p = 0.0019) decreased survival, whereas reoperation
improved survival (p = 0.0007). The improvement in survival with
reoperation was particularly strong for patients with a stenotic vein graft
to the left anterior descending artery. For that subset, survival was 84%
and 74% for the REOP group versus 76% and 53% for the MED group at 2 and 4
years after catheterization, respectively (p = 0.004). For patients with
stenotic vein grafts to the right coronary artery or circumflex coronary
artery (or both), survival was 92% and 87% for the REOP group versus 89%
and 78% for the MED group at 2 and 4 years after catheterization,
respectively (p = 0.13). Even for patients with class I or II symptoms,
reoperation prolonged survival (p = 0.002 with multivariate testing).
Reoperation improves the survival of patients with late vein graft
stenoses, particularly those with stenotic grafts to the left anterior
descending coronary artery.
ARTICLES
The effect of coronary reoperation on the survival of patients with stenoses in saphenous vein bypass grafts to coronary arteries
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
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