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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 847-859, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
BW Lytle, FD Loop, DM Cosgrove, PC Taylor, M Goormastic, W Peper, CC Gill, LA Golding and RW Stewart
Fifteen hundred consecutive patients undergoing a first reoperation for
coronary revascularization were reviewed to determine early and late
results and predictors of survival. Patients were subdivided into cohorts
on the basis of the year of reoperation: Group A (1967 to 1978, 436
patients); Group B (1979 to 1981, 439 patients); and Group C (1982 to 1984,
625 patients). Overall operative mortality was 3.4% (51 deaths): 4.6%,
2.3%, and 3.4% for Groups A, B, and C, respectively. Group C had
significantly more women (p = 0.01) and patients with triple-vessel
disease, left main coronary artery stenosis (greater than or equal to 50%),
abnormal left ventricular function, age greater than or equal to 70 years,
and graft failure as a surgical indication (all p less than 0.001). The
mean interval between operations increased from 50 months for Group A to 84
months for Group C. At reoperation, Group C patients received more grafts,
more internal mammary artery grafts, and had a higher prevalence of
complete revascularization (all p less than 0.001). Univariate and
multivariate analyses identified left main stenosis (p less than 0.0001),
Class III or IV symptoms (p = 0.0002), advanced age (p = 0.0006), Group A
(p = 0.02), and incomplete revascularization (p = 0.004) as predictors of
increased in-hospital mortality. Follow-up of in-hospital survivors (mean
interval 54 months, range 13 to 171 months) documented a 5 year survival
rate of 90% and a 10 year survival rate of 75%. Multivariate testing
identified advanced age (p less than 0.0001), hypertension (p less than
0.0001), and abnormal left ventricular function (p less than 0.0001) as
predictors of decreased late survival.
ARTICLES
Fifteen hundred coronary reoperations. Results and determinants of early and late survival
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