The Journal of Thoracic and Cardiovascular Surgery, Vol 72, 849-853, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Experience with fifty repeat procedures for myocardial revascularization
QR Stiles, GG Lindesmith, BL Tucker, RK Hughes and BW Meyer
Fifty coronary reoperations were performed in 49 patients. The reasons for
the operations were occluded or stenotic grafts in 23 patients, an
inadequate first operation in 13, progression of coronary atherosclerosis
in 3, and combinations of these reasons in 11. Mediastinal adhesions made
the operations difficult and produced hazards. Six patients died from the
operation. Seven surgical mishaps occurred, including damage to five
functioning grafts from the previous operation and laceration of two
ventricles. Nine patients had less than complete operations because
angiographically demonstrated targets could not be found. Repeat
angiography was performed on 9 of the surviving patients. Ten of the 14 new
or revised grafts were found to be functioning. Although a repeat operation
is more difficult technically and carries additional risks as compared with
a first operation, the indications are thought to be the same for both
first and secondary revascularization procedures. The increased risks of
the repeat operations are compelling arguments to strive for complete
revascularization at an initial operation in order to avoid the necessity
of the second one.
