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PubMed2002

Proximal aortic reoperations in patients with composite valve grafts.

BACKGROUND: The purpose of this study was to examine our experience with proximal aortic reoperations in patients with composite valve grafts (CVGs) and assess postoperative survival and morbidity. METHODS: Since 1991, 33 patients with CVGs underwent reoperation for one or more of the following indications: aneurysms distal to the CVG (n = 20, 61%), false aneurysms (n = 13, 39%) and graft infection (n = 7, 21%). Operations included false aneurysm repair (n = 13, 39%), graft replacement of distal ascending aortic or transverse aortic arch aneurysm (n = 20, 61%) and aortic root re-replacement with a new CVG (n = 6, 18%) or homograft (n = 4, 12%). RESULTS: Operative mortality was 15% (n = 5), including 2 of the 7 patients who had infected CVGs (29%). All 4 patients who had infected CVGs replaced with aortic root homografts survived. Complications included vocal cord paralysis (n = 4, 12%), bleeding requiring reoperation (n = 3, 9%) and stroke (n = 2, 6%). Actuarial 3-year survival was 74.4% +/- 7.9%. CONCLUSIONS: Reoperations in patients with CVGs remain challenging procedures with high associated morbidity and mortality, especially in the setting of graft infection. The results of homograft aortic root re-replacement for infected CVGs are encouraging.

Adult↗
PubMed1985

Reoperation in congenital aortic stenosis.

Over a 22-year period, 81 patients underwent initial operations for critical aortic stenosis at our institution. Their ages ranged from 3 days to 20 years (mean, 7.3 +/- 5.9 years). Fourteen (17%) were infants less than 1 year old. Three children died perioperatively (3.7%). We have followed the survivors and 3 children who underwent initial operations elsewhere for a mean of 9.0 +/- 6.8 years (range, 2 to 23 years). To the present, 27 patients have undergone one reoperation (24 of our initial survivors) at a mean interval of 7.3 years, with 2 perioperative deaths. Ten of these patients have required a second reoperation at a mean interval of 3.7 years, with 2 deaths perioperatively. There were 3 late cardiac deaths after the initial procedure and 1 after a third operation. Actuarial reoperation-free survival is 56.7% at 10 years. While overall survival is 88.6% at 10 years, we find a significantly poorer survival among those patients with valvular stenosis compared with those with subvalvular lesions (p = 0.03). We believe that for children with all levels of aortic stenosis, good functional results and survival can best be obtained by follow-up, recatheterization, and reoperation.

Actuarial Analysis↗
PubMed1985

Reoperation after previous grafting with the internal mammary artery: technique and early results.

Among 1,006 patients undergoing coronary bypass reoperation from 1968 through 1982, 100 had a patent internal mammary artery graft. There were 88 men and 12 women with a mean age of 53.4 years and a mean interval between first and second operations of 56.6 months. Reasons for reoperation were vein graft closure in 26% of the patients, progressive disease in previously ungrafted arteries in 48%, and combined indications in 26%. One operative death occurred. There was no significant difference in morbidity when compared with a reference group of 906 reoperations in patients without IMA grafting. Complete revascularization was achieved in 64% of the patients; the mean number of grafts per patient was 1.6. Seven patients had a perioperative myocardial infarction, and eight mammary artery pedicles were damaged during reoperation.

Coronary Disease↗
PubMed1987

Reoperations for left-sided low-profile mechanical prosthetic obstructions.

A series of 2,474 hospital survivors of primary mitral, aortic, and double mitral-aortic valve replacement were observed for a cumulative period of 11.945 years (mean, 4.2 years; range, 0.6-14 years). The linearized incidences of reoperations for thrombotic obstructions were 0.33 +/- 0.08% for mitral valve replacement, 0.36 +/- 0.1% for aortic valve replacement, and 0.42 +/- 0.1% for double valve replacement (p = not significant). Forty-one patients (16 mitral, 12 aortic, and 13 double valve replacements) underwent a total of 44 reoperations with a mean interval of 36 +/- 29 months (range, 0.25-85 months) between operations. Diagnosis was established invasively only in 13 patients (30%). Hospital mortality at reoperation was 18% (8 patients); 28 patients (63%) required emergency surgery. The choice surgical procedures were thrombectomy for clotted aortic prostheses (18 of 24) and valve replacement for obstructed mitral valves (22 of 25; p less than .001). Rethrombosis occurred in 3 patients (1 aortic and 2 double valve replacements). At hospital admission 17 patients (38%) had prothrombin times outside therapeutic ranges (between 20 to 30% of the normal value). The incidence of reoperations for thrombosis in low-profile mechanical prostheses was unaffected by valvar position and number of prostheses implanted. Rethrombosis occurred only in previously cleaned valves, although its occurrence was not significant. The present results indicate that, as experience is gained in the diagnosis and surgical management of this complication, hospital mortality can be reduced significantly (from 37% to 4%).

Aortic Valve↗
PubMed1997

Reoperative coronary bypass grafting without cardiopulmonary bypass through a small thoracotomy.

BACKGROUND: The danger of coronary reoperations is mainly hidden in the reopening of the sternum and in the manipulation of the heart and the old grafts. Therefore, the minimally invasive direct coronary artery bypass procedure seems an ideal technique for coronary reoperations if only the left anterior descending coronary artery needs to be revascularized and the left internal mammary artery has not been used previously. METHOD: From January 1995 until May 1996 we performed 81 minimally invasive direct coronary artery bypass procedures through a small anterolateral thoracotomy in the fifth intercostal space, anastomosing the left internal mammary artery to the left anterior descending coronary artery. Six of these 81 were reoperative minimally invasive direct coronary artery bypass procedures on patients who had previously undergone coronary grafting through a median sternotomy with a vein graft to the left anterior descending coronary artery. RESULTS: Mean operation time was 85.8 +/- 22.2 minutes. Mean length of the mammary pedicles was 13 +/- 2 cm. Mean coronary occlusion time was 9.2 +/- 3.2 minutes. Mean postoperative hospital stay was 5.7 +/- 1.2 days (range, 5 to 8 days). No mortality and no cardiac-related morbidity were recorded. CONCLUSIONS: These results suggest that the technique is safe and promising in selected cases of reoperative coronary operation.

Aged↗
PubMed1999

Cardiac reoperations in octogenarians: analysis of outcomes.

BACKGROUND: With the rapid growth of the elderly segment of the population, more octogenarians are referred for complex cardiac interventions, including reoperations. Data regarding the outcomes, quality of life, and long-term results after reoperative open-heart surgical procedures in octogenarians are scarce. METHODS: We retrospectively studied 113 consecutive octogenarians (mean age, 83+/-2.6 years) who underwent reoperative cardiac procedures within a 13-year period. Coronary artery bypass grafting (CABG) was performed in 49 patients (CABG group), valvular procedures (aortic, mitral, or tricuspid valve, alone or in combination) in 35 (valve group), and combined CABG and valve intervention in 29 (combined CABG and valve group). RESULTS: The 30-day mortality rate was 8% (4 of 49) for the CABG group, 9% (3 of 35) for the valve group, and 17% (5 of 29) for the combined CABG and valve group. One- and 5-year actuarial survival rates were, respectively, 85%+/-5% and 58%+/-10% for the CABG group, 78%+/-7% and 53%+/-12% for the valve group, and 69%+/-9% and 63%+/-10% for the combined CABG and valve group. Sixty-one percent of patients in the CABG group, 40% in the valve group, and 38% in the combined CABG and valve group were in New York Heart Association class I or II postoperatively at a mean follow-up time of 2.1+/-2.4 years. Similarly, 91%, 85%, and 80%, respectively, thought that they had an improved quality of life and were satisfied with their functional status. CONCLUSIONS: Cardiac reoperations can be performed successfully in most octogenarians, although with an increased risk, particularly in the combined CABG and valve group. Long-term survival is acceptable with improved quality of life and functional status. However, it is possible that these results could be improved in this high-risk group of patients with earlier referral and surgical intervention, for the effective use of health care resources.

Aged↗
PubMed1999

Reoperation after esophageal replacement in childhood.

BACKGROUND: Esophageal replacement is associated with significant morbidity that may lead to operative interventions. This study reviews the management and outcome of children who underwent reoperation after esophageal replacement. METHODS: Eighteen patients who underwent esophageal replacement from 1985 to 1997 were reviewed retrospectively. Ten patients underwent reoperation. Patient management, perioperative morbidity, and the dietary intake at follow-up were recorded for each patient. RESULTS: Of the reoperated patients, 7 had esophageal atresia, 2 had caustic ingestion, and 1 had achalasia. Nine patients received a colon interposition, and 1 received a reverse gastric tube as the initial esophageal replacement. Seven patients required revision of the anastomoses. Three patients required complex esophageal reconstruction: 1 underwent gastric transposition, 1 underwent free jejunal graft, and 1 underwent gastric transposition combined with free jejunal graft. Seven patients were eating well at follow-up. Two patients still required partial gastrostomy tube feeding. One patient died 6 months postoperatively from aspiration pneumonia. CONCLUSIONS: Esophageal replacement continues to be a challenging operation associated with significant complications. Most reoperative procedures were directed toward strictures and persistent fistulae. Complete graft failure can be managed by gastric transposition or free jejunal graft. Despite the perioperative morbidity, most patients have good functional outcome.

Adolescent↗
PubMed1995

Determinants of operative mortality in reoperative coronary artery bypass grafting.

Previously suggested risk factors for operative mortality in reoperative coronary artery bypass grafting are contradictory. Therefore, we analyzed our data of 622 patients who underwent reoperative bypass grafting from January 1986 through June 1993. Among these patients, 258 had saphenous vein grafts alone and 364 had internal mammary artery grafting, including unilateral (342 patients) and bilateral (22 patients) mammary artery grafting with or without additional saphenous vein grafting. Overall operative mortality was 11.4% for reoperation compared with only 3.6% for primary bypass grafting during the same time frame. To determine risk factors for mortality and the influence of internal mammary artery grafting on the outcome, we analyzed 82 variables (31 preoperative, 17 intraoperative, and 34 postoperative) by univariate analysis. Significant variables or the variables having a trend (p < 0.2) to be associated with the mortality were included in stepwise multiple logistic regression analyses. Two regression analyses were separately performed. Regression 1 only included preoperative and intraoperative variables whereas regression 2 included postoperative variables as well. The logistic regressions demonstrate that preoperative variables (low ejection fraction [p = 0.0002], old age [p = 0.003], female gender [p = 0.011], and history of arrhythmia [p = 0.023]), intraoperative variables (emergency operation [p = 0.0001] and long perfusion time [p = 0.0001]), and postoperative variables (complications) are independently associated with higher mortality. Unlike previously described results, aortic crossclamp time, route of cardioplegia, use of internal mammary artery, number of grafts, and year of operation are not associated with operative mortality. The identification of these risk factors may have important implications in further improvement of the results of reoperative coronary artery bypass grafting.

Cause of Death↗
PubMed1997

Long-term results after reoperation for failed antireflux procedures.

From January 1960 to June 1995, 185 patients underwent reoperation without esophageal resection for symptoms of recurrent gastroesophageal reflux disease. There were 102 men and 83 women. Median age was 58 years (range 20 to 84 years). A single previous antireflux operation had been performed in 147 patients, two in 33, and three in 5. The median interval between the reoperation and the previous operation was 36 months (range 1 to 291 months). Indications for reoperation were symptoms in 184 patients and a large paraesophageal hernia in one patients. The surgical approach was by means of a thoracotomy in 133 patients (71.9%), laparotomy in 27 (14.6%), and a thoracoabdominal incision in 25 (13.5%). A Nissen fundoplication was performed in 107 patients (57.8%), Belsey fundoplication in 47 (25.4%), truncal vagotomy and antrectomy with Roux-en-Y reconstruction in 17 (9.2%), anatomic hernia repair in 12 (6.5%), and Hill gastropexy in 2 (1.1%). A Collis gastroplasty was added to the fundoplication in 116 patients (62.7%), and a pyloroplasty was performed in 17 (9.2%). There was one operative death (0.5%). Complications occurred in 47 patients (25.4%). Median postoperative hospitalization was 9 days (range 5 to 58 days). Follow-up was complete in 156 patients (84.3%) and ranged from 3 to 283 months (median 44 months). Improvement occurred in 137 patients (87.8%). Functional results were classified as excellent in 65 patients (41.6%), good in 29 (18.6%), fair in 43 (27.6%), and poor in 19 (12.2%). No single operative approach or procedure proved to be functionally superior. We conclude that reoperation with esophageal preservation after a failed antireflux procedure will result in significant functional benefit and can be performed with low mortality and acceptable morbidity. The type of repair should be tailored to the individual patient.

Adult↗
PubMed1998

Prospective, randomized trial comparing blood and oxygenated crystalloid cardioplegia in reoperative coronary artery bypass grafting.

OBJECTIVES: Reoperative coronary artery bypass grafting presents unique challenges for myocardial preservation. The purpose of this study was to compare oxygenated blood cardioplegia with oxygenated crystalloid cardioplegia during reoperative coronary artery bypass grafting using transesophageal echocardiography to assess regional wall motion of the left ventricle before and after cardiopulmonary bypass. METHODS: Sixty-one patients undergoing reoperative coronary artery bypass grafting were prospectively randomized to receive oxygenated blood cardioplegia or oxygenated crystalloid cardioplegia delivered with a combined antegrade-retrograde technique. Transgastric short axis views of the left ventricle were made with transesophageal echocardiography during the operation before cardiopulmonary bypass and immediately after cardiopulmonary bypass. Regional wall motion was graded by a blinded observer, and before cardiopulmonary bypass scores were compared with after cardiopulmonary bypass scores. RESULTS: No significant differences were found in the change in regional wall motion score from before cardiopulmonary bypass to after cardiopulmonary bypass between the blood and crystalloid cardioplegia groups. CONCLUSIONS: This study found blood and crystalloid cardioplegia to be equally efficacious for myocardial preservation during reoperative coronary artery bypass grafting.

Bicarbonates↗
PubMed1996

Is reoperation for gastrinoma excision indicated in Zollinger-Ellison syndrome?

BACKGROUND: Surgical excision of gastrinomas in patients with Zollinger-Ellison syndrome (ZES) decreases the incidence of hepatic metastases, but long-term biochemical cures are achieved in fewer than 30% of cases. A growing number of patients have persistent or recurrent disease after initial operation. The effect of reoperation in these patients has not been previously reported. METHODS: From December 1982 to August 1995, 120 patients with ZES underwent operation for gastrinoma resection. Seventy-eight patients had recurrent or persistent ZES after operation; 17 patients underwent 18 reoperations. After initial operation all patients underwent yearly functional and imaging studies. If a tumor was unequivocally imaged, reexploration was done. RESULTS: Five patients, all with sporadic disease, were disease free after operation, with a median follow-up of 28 months. Tumor was found in all 18 reoperations and resected in 17. In patients with continuing disease-free intervals, locations of gastrinomas included pancreatic head lymph nodes (three), liver metastasis (one), and pancreatic tail lymph node (one). There were no deaths in the cured group; two patients in the group with persistent disease have died (median follow-up, 34 months). CONCLUSIONS: Reoperation for gastrinoma excision resulted in elimination of disease in 30% of patients and should be considered for patients with imageable disease.

Adult↗
PubMed1997

Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma.

BACKGROUND: Recurrence of adrenal cortical carcinoma (ACC) after radical surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical treatment for recurrent ACC in a multiinstitutional series. METHODS: One hundred eighty-eight cases of ACC were collected in a national registry. A complete follow-up was obtained in 179 cases. At initial diagnosis 92 patients had local disease (stage I or II). One hundred seventy patients underwent surgical treatment, considered radical in 140; in this group, recurrent disease was observed in 52 cases (37%) after a mean disease-free interval of 21.7 months. RESULTS: Adjuvant chemotherapy was ineffective in ameliorating the prognosis. The mean survival in 20 patients who underwent reoperation was significantly higher (15.85 +/- 14.9 months) than in nonreoperated cases (3.2 +/- 2.9 months). Five-year actuarial survival in reoperated patients is significantly better than in nonreoperated patients (49.7% versus 8.3%, respectively). CONCLUSIONS: Although the prognosis of this tumor is still poor, surgery is the only effective therapy; reoperation allows survival comparable to that observed in patients without recurrent disease. An aggressive strategy for recurrent ACC is advisable until prospective studies demonstrate a real effectiveness for chemotherapy.

Adolescent↗
PubMed1991

Reoperation for failed gastric bypass procedures for obesity.

Reoperation is worthwhile when there is an obvious defect in the gastric reduction operation that has failed to control weight. Reoperation occasionally is necessary to correct a complication of gastric bypass. Vertical banded gastroplasty is the operation of choice for reoperations, as it provides weight control while eliminating the problems of bypass. Conversion of a horizontal to a vertical pouch is safe but requires careful attention to the technique to avoid injury to the other organs in the area and preservation of blood supply to the stomach. The gastrogastrostomy across the old horizontal staple line in the vertical pouch can be constructed in a way that will minimize the risk of obstruction. Vertical banded gastroplasty is now the only operation in use at UIHC for the treatment of obesity and is used not only as the primary operation but in all reoperations. Bypass of the stomach and duodenum is not necessary for weight control and adds some risk of malabsorption and duodenal and stomal ulcer plus a lifetime of inaccessibility of the excluded areas for diagnostic and therapeutic measures.

Animals↗
PubMed1997

Reoperation for recurrent trigeminal neuralgia after microvascular decompression.

BACKGROUND: Microvascular decompression (MVD) is an effective technique for those who have trigeminal neuralgia (TN) but cannot tolerate, or show no response to medicine. Though the initial success rate is high, some patients may develop severe recurrent neuralgia, especially after a longer period of follow-up. The efficacy of reoperation needs to be evaluated. To know the possible risk factors of recurrence after initial MVD is mandatory to the management of recurrent TN. METHODS: Among the 80 cases of TN treated with MVD, five cases showed severe recurrent symptoms within a follow-up period from 9 months-4 years. The symptoms recurred on the same side of the face, and were unresponsive to medical treatment. Brain computed tomography (CT) and magnetic resonance imaging (MRI) may reveal the etiology of recurrence. Repeat decompression of the trigeminal nerve was the main goal of reoperation, which was done via a suboccipital approach. RESULTS: Over the past 17 years, 80 MVDs for TN have been performed at Chang Gung Memorial Hospital. There were five cases of serious postoperative recurrence, which could not be relieved by medicine. Recurrence occurred 1 day-12 months after the initial surgery. Three cases were due to vascular compression, while two were caused by the local effect of Teflon felt. Reoperation produced complete remission in four patients, and partial remission in one. CONCLUSIONS: An increasing number of patients may experience severe recurrent TN after initial MVD during a long period of follow-up. Reoperation is safe and beneficial for these patients, but the results are dependent on the etiology of the recurrence. Further vascular compression of the trigeminal nerve can be relieved by MVD. Otherwise, in cases of severe adhesion caused by Teflon, complete microneural lysis can achieve satisfactory results.

Adult↗
PubMed1999

Immediate reoperation for perioperative stroke after 2250 carotid endarterectomies: differences between intraoperative and early postoperative stroke.

PURPOSE: After carotid endarterectomy, intraoperative findings and outcome of immediate reoperation of patients who had an intraoperative stroke were compared with those of patients who had an early postoperative stroke. METHODS: We retrospectively analyzed 2250 carotid endarterectomies performed between 1980 and 1997. Intraoperative stroke (group A) was detected after 41 of the 2250 operations (1.8%), whereas early postoperative stroke (group B) developed after 18 of the 2250 operations (0.8%). Patients from both groups were reoperated on within 1 hour after neurological examination. RESULTS: Positive intraoperative findings that could be corrected during immediate reoperation were: (1) thrombotic occlusion of the carotid artery that was operated on caused by technical error, which was found in nine of 41 patients (22%) in group A and in 11 of 18 patients (61%) in group B (P =.009); (2) mural thrombus caused by technical error without occlusion, which was detected in seven of 41 patients (17%) in group A and in two of 18 patients (11%) in group B (P >.05); and (3) technical error without a thrombus, which was found in eight of 41 patients (20%) in group A and in three of 18 patients (17%) in group B (P >.05). A patent carotid artery was found in 17 of 41 patients (42%) in group A and in two of 18 patients (11%) in group B (P =.046). Twenty of the 41 patients (49%) in group A died, and four of 18 patients (22%) in group B died (P > 0.05). Major neurological deficit remained in nine of 41 patients (22%) in group A and four of 18 patients (22%) in group B (P > 0.05). Total recovery occurred in seven of 41 patients (17%) in group A and in eight of 18 patients (45%) in group B (P = 0.058). CONCLUSION: Carotid artery thrombosis during immediate reoperation was more frequent in patients who had an early postoperative stroke than in patients who had an intraoperative stroke. It appears that patients who had an intraoperative stroke have a higher incidence of uncorrectable lesions.

Carotid Stenosis↗
PubMed1999

Reoperation for carotid stenosis is as safe as primary carotid endarterectomy.

PURPOSE: Patients with recurrent carotid artery stenosis are sometimes referred for carotid angioplasty and stenting because of reports that carotid reoperation has a higher complication rate than primary carotid endarterectomy. The purpose of this study was to determine whether a difference exists between outcomes of primary carotid endarterectomy and reoperative carotid surgery. METHODS: Medical records were reviewed for all carotid operations performed from September 1993 through March 1998 by vascular surgery faculty at a single academic center. The results of primary carotid endarterectomy and operation for recurrent carotid stenosis were compared. RESULTS: A total of 390 operations were performed on 352 patients. Indications for primary carotid endarterectomy (n = 350) were asymptomatic high-grade stenosis in 42% of the cases, amaurosis fugax and transient ischemic symptoms in 35%, global symptoms in 14%, and previous stroke in 9%. Indications for reoperative carotid surgery (n = 40) were symptomatic recurrent lesions in 50% of the cases and progressive high-grade asymptomatic stenoses in 50%. The results of primary carotid endarterectomy were no postoperative deaths, an overall stroke rate of 1.1% (three postoperative strokes, one preoperative stroke after angiography), and no permanent cranial nerve deficits. The results of operations for recurrent carotid stenosis were no postoperative deaths, no postoperative strokes, and no permanent cranial nerve deficits. In the primary carotid endarterectomy group, the mean hospital length of stay was 2.6 +/- 1. 1 days and the mean hospital cost was $9700. In the reoperative group, the mean length of stay was 2.6 +/- 1.5 days and the mean cost was $13,700. The higher cost of redo surgery is accounted for by a higher preoperative cerebral angiography rate (90%) in redo cases as compared with primary endarterectomy (40%). CONCLUSION: In this series of 390 carotid operations, the procedure-related stroke/death rate was 0.8%. There were no differences between the stroke-death rates after primary carotid endarterectomy and operation for recurrent carotid stenosis. Operation for recurrent carotid stenosis is as safe and effective as primary carotid endarterectomy and should continue to be standard treatment.

Aged↗
PubMed2000

A novel repair for patients with atrioventricular septal defect requiring reoperation for left atrioventricular valve regurgitation.

OBJECTIVE: Left atrioventricular valve regurgitation (LAVVR) is the most frequent indication for reoperation following atrioventricular septal defect (AVSD) repair. We estimate from our experience that within 10 years of initial repair, 14% of patients undergoing repair of atrioventricular septal defect (AVSD) require reoperation for this complication. We have developed a novel leaflet augmentation technique for LAVVR which may avoid failure of conventional repair and/or the need for valve replacement. METHOD: The novel technique consists of insertion of a glutaraldehyde-treated autologous pericardial patch to augment the bridging leaflets of the atrioventricular valve. We describe the outcome of eight patients in whom this technique was used and compared them to 68 other patients with AVSD undergoing reoperation for LAVVR by either conventional repair (n=54) or valve replacement (n=14). RESULTS: There were no early deaths or major complications following patch repair. The mean follow-up is 2.3 years (range 1-8.5 years) during which there were no late deaths. Two patients underwent reintervention at 3.5 and 5 years after patch repair for LAVVR and were successfully rerepaired. Mild residual LAVVR was seen at last echocardiography in six patients and mild to moderate in two. These results compare favorably with the 68 patients who underwent conventional surgery. The 3-year freedom from reoperation was 86% for both repair groups. Dysplastic valve tissue appears to be a major risk factor for failure of conventional repair or for valve replacement. Failure of conventional valve repair led to valve replacement in six of seven patients. CONCLUSIONS: For patients with late LAVVR after AVSD repair, pericardial leaflet augmentation is durable and may avoid failure of conventional repair or valve replacement in patients with dysplastic valves.

Adolescent↗
PubMed1997

Reoperative coronary artery bypass procedures: risk factors for early mortality and late survival.

OBJECTIVES: The number of coronary artery disease reoperations is increasing. The aim of this paper is to identify risk factors and evaluate the results of REDO coronary artery bypass grafting (CABG). MATERIAL: Between January 1984 and October 1994, 594 patients underwent REDO-CABG and 3157 underwent primary-CABG. The mean age was 62 years with 84% men. Hypertension, hyperlipidemia, insulin dependent diabetes, smoking and renal insufficiency were all more frequent in the REDO-group. A significantly higher number of patients undergoing REDO-CABG were in the Canadian Cardiovascular Society (CCS) angina class 3 and 4, had instable angina, had left main stem stenosis of greater than 70% and 3-vessel disease compared to those undergoing primary-CABG. The mean preoperative left ventricular function (LVEF) was 49.8 (REDO) vs. 58.2%, with a P value of less than 0.001. RESULTS: The overall postoperative mortality rate for REDO-operations was 9.6 (57/594) vs. 2.8% for primary-CABG. Patients with a reoperative interval of more than 1 year had an 8.9% mortality rate, compared to those reoperated less than 1 year after the initial CABG, where the mortality was 21% with a P value of less than 0.05. Postoperative low cardiac output syndrome, intraaortic balloon pump support, prolonged ventilatory support (> 24 h), hemorrhage and gastrointestinal complications were prominent features of the REDO-group (all P < 0.01). Urgent operation, CCS class 3 and 4, LVEF of less than 40%, generalized arteriosclerotic disease and advanced age (> 80 years) were independent risk factors for postoperative death in both groups. Preoperative renal insufficiency, diabetes and short interval from primary-CABG were added risk factors in the REDO-group. The 5-years survival rate after REDO-CABG was 89%, while the cardiac event-free survival rate was 79% and at 7 years 84 and 62%, respectively. CONCLUSIONS: Reoperative CABG is effective, but has an increased operative mortality and morbidity. The long-term results are encouraging. Unstable angina, poor preoperative left ventricular function, renal insufficiency, insulin dependant diabetes and an interval shorter than 1 year of the initial operation were independent riskfactors for mortality.

Adult↗