HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Floyd D. Loop Bruce W. Lytle Delos M. Cosgrove Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brener, S. J. Articles by Topol, E. J. Search for Related Content PubMed PubMed Citation Articles by Brener, S. J. Articles by Topol, E. J.

J Thorac Cardiovasc Surg 1997;114:153-161
© 1997 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

A PROFILE OF CANDIDATES FOR REPEAT MYOCARDIAL REVASCULARIZATION: IMPLICATIONS FOR SELECTION OF TREATMENT

Received for publication Sept. 17, 1996 Revisions requested Feb. 13, 1997; revisions received March 7, 1997 Accepted for publication March 7, 1997. Address for reprints: Floyd D. Loop, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave., H18, Cleveland, OH 44195.

Abstract

Objectives: It is not known whether the results of randomized trials comparing coronary artery bypass grafting to percutaneous transluminal coronary angioplasty for initial revascularization apply to repeat revascularization in patients with prior bypass grafts. We studied the differences between the patients with prior bypass grafts referred for surgery or angioplasty to identify the clinical and angiographic characteristics that correlated best with either choice and to find clues that might aid in selecting one treatment over the other. Methods: Between 1992 and 1904, 870 patients underwent first isolated reoperation and 793 patients underwent first balloon angioplasty after a previous operation. A jeopardy score (0 to 8 points) was derived for each patient on the basis of the relative size of the ischemic territory. Clinical and angiographic data were analyzed for association with the revascularization strategy. Results: The following characteristics were more prevalent in the reoperation group: male sex, diabetes, hypertension, valvular disease, normocholesterolemia, and severe left ventricular systolic dysfunction; fewer functioning venous and arterial grafts; and a higher jeopardy score (p < 0.01 for all) than in the angioplasty group. A higher jeopardy score, diabetes, and a lower number of functioning arterial or venous grafts were strong, independent predictors of referral for reoperation (p < 0.01 for all). In-hospital death and Q-wave infarction (p < 0.01 for both) were more frequent in the reoperation group. Conclusions: Reoperation was the revascularization procedure of choice when larger regions of myocardium were in jeopardy. Angioplasty was more frequently chosen in the presence of a patent arterial graft to the left anterior descending coronary artery or multiple functioning bypass grafts. Reoperation was associated with a higher risk of in-hospital complications than angioplasty.

This article has been cited by other articles:

				S. J. Brener, B. W. Lytle, I. P. Casserly, S. G. Ellis, E. J. Topol, and M. S. Lauer Predictors of revascularization method and long-term outcome of percutaneous coronary intervention or repeat coronary bypass surgery in patients with multivessel coronary disease and previous coronary bypass surgery Eur. Heart J., February 2, 2006; 27(4): 413 - 418. [Abstract] [Full Text] [PDF]

				L. Noyez and F. M. van Eck Long-term cardiac survival after reoperative coronary artery bypass grafting Eur. J. Cardiothorac. Surg., January 1, 2004; 25(1): 59 - 64. [Abstract] [Full Text] [PDF]

				F. M. van Eck, L. Noyez, F. W.A. Verheugt, and R. M.H.J. Brouwer Changing profile of patients undergoing redo-coronary artery surgery Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 205 - 211. [Abstract] [Full Text] [PDF]

				M. A. Borger, V. Rao, R. D. Weisel, A. A. Floh, G. Cohen, C. M. Feindel, H. E. Scully, L. L. Mickleborough, and T. M. Yau Reoperative coronary bypass surgery: Effect of patent grafts and retrograde cardioplegia J. Thorac. Cardiovasc. Surg., January 1, 2001; 121(1): 0083 - 90. [Abstract] [Full Text] [PDF]

				T. M. Yau, M. A. Borger, R. D. Weisel, and J. Ivanov The changing pattern of reoperative coronary surgeryTrends in 1230 consecutive reoperations J. Thorac. Cardiovasc. Surg., July 1, 2000; 120(1): 156 - 163. [Abstract] [Full Text] [PDF]

				P. Sergeant, E. Blackstone, B. Meyns, B. Stockman, and R. Jashari First cardiological or cardiosurgical reintervention for ischemic heart disease after primary coronary artery bypass grafting Eur. J. Cardiothorac. Surg., November 1, 1999; 14(5): 480 - 487. [Abstract] [Full Text] [PDF]

				A. M. Gillinov, F. P. Casselman, B. W. Lytle, E. H. Blackstone, E. M. Parsons, F. D. Loop, and D. M. Cosgrove III Injury to a patent left internal thoracic artery graft at coronary reoperation Ann. Thorac. Surg., February 1, 1999; 67(2): 382 - 386. [Abstract] [Full Text] [PDF]

				F. D. Loop Coronary artery surgery: the end of the beginning Eur. J. Cardiothorac. Surg., December 1, 1998; 14(6): 554 - 571. [Abstract] [Full Text] [PDF]