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The Journal of Thoracic and Cardiovascular Surgery, Vol 85, 508-515, Copyright © 1983 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
HV Schaff, TA Orszulak, BJ Gersh, JM Piehler, FJ Puga, GK Danielson and JR Pluth
To determine late survival and functional status after second
revascularization procedures for coronary artery disease, we studied 106
consecutive patients operated on between June, 1969, and December, 1980.
The mean age of the 96 men and 10 women was 49 +/- 8 years (range 22 to 65
years). Before reoperation, 101 patients (95%) were judged to be in New
York Heart Association Class III or IV with angina, and 81 patients (76%)
had three-vessel involvement. Angina recurrence was most commonly caused by
bypass graft occlusion alone and in combination with progressive disease of
the native arteries (60 patients, 57%). Three patients (2.8%) died within
30 days of reoperation; each death resulted from myocardial infarction. An
average of 2.2 coronary arteries were bypassed in each patient. Complete
follow-up data (mean 43 months) were available for 105 patients. Actuarial
survival of patients dismissed alive is 94% at 5 years and 89% at 7 years.
All late cardiac-related deaths occurred in patients with three-vessel
disease. When recurrence of any angina, need for a third operation, and
myocardial infarction are included with cardiac-related deaths, event-free
survival is 28% at 5 years and 26% at 7 years. Late survival and functional
status could not be predicted by the cause of recurrent angina or the
presence of risk factors. Repeat myocardial revascularization can
apparently be undertaken with low risk and with prospects for excellent
long-term survival. After reoperation, recurrence of mild angina is not
uncommon, but freedom from serious cardiac events and relief of severe
symptoms were noted in more than 60% of patients 5 years later.
ARTICLES
The morbidity and mortality of reoperation for coronary artery disease and analysis of late results with use of actuarial estimate of event- free interval
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