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J Thorac Cardiovasc Surg 2001;121:0083-0090
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Reoperative coronary bypass surgery: Effect of patent grafts and retrograde cardioplegia

From the Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, and the Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Supported in part by the Heart and Stroke Foundation of Ontario (HSFO). M.A.B. is a Research Fellow of the HSFO. R.D.W. is a Career Investigator of the HSFO.

Received for publication May 4, 2000. Revisions requested July 31, 2000; revisions received Aug 28, 2000. Accepted for publication Sept 3, 2000. Address for reprints: Terrence M. Yau, MD, MSc, Toronto General Hospital, EN 13-239, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4 (E-mail: terry.yau{at}utoronto.ca).

Objective: To determine the effects of patent or diseased aorta-coronary bypass grafts and retrograde cardioplegia on mortality during reoperative coronary bypass surgery.
Methods: We conducted a retrospective review of prospectively gathered data, supplemented by systematic chart review, of all patients (n = 744) undergoing reoperative coronary bypass surgery at our institution between 1990 and 1997. Independent predictors of survival were determined by stepwise logistic regression analysis.
Results: At least one patent or stenosed graft to the left anterior descending artery was present in 50% of patients, to the circumflex territory in 27% of patients, and to the right coronary artery territory in 33% of patients. The previous left anterior descending graft was a saphenous vein in 82% and a left internal thoracic artery in 18% of patients. In-hospital mortality occurred in 42 (5.6%) patients. Patent or diseased grafts of any coronary artery territory did not significantly increase the risk of mortality. Retrograde cardioplegia use increased in more recent years, was more frequent in patients with stenosed grafts, and was associated with improved survival. Independent predictors of mortality were as follows (with odds ratios and 95% confidence intervals in parentheses): failure to use retrograde cardioplegia (odds ratio 2.81; 1.28-6.20), New York Heart Association class (odds ratio 2.69; 1.25-5.81), peripheral vascular disease (odds ratio 2.60; 1.25-5.41), and left ventricular grade (2.07; 1.31-3.27).
Conclusions: In this series, patent or stenosed grafts were not associated with an increased risk of mortality during reoperative coronary bypass surgery, possibly because of increased use of retrograde cardioplegia in this patient group. We strongly recommend the routine use of retrograde cardioplegia during redo coronary bypass surgery.