The Journal of Thoracic and Cardiovascular Surgery, Vol 73, 181-188, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Reoperations for myocardial revascularization
MJ Irarrazaval, DM Cosgrove, FD Loop, CL Ennix Jr, LK Groves and PC Taylor
Reoperations solely for myocardial revascularization were performed in 219
consecutive patients (1967 to 1975). Indications were (1) graft failure, 46
(21 per cent); (2) progressive atherosclerosis, 42 (19 per cent); (3)
incomplete revascularization, 39 (18 per cent); and (4) combinations, 92
(42 per cent). Primary operations included bypass grafts in 100 patients;
mammary artery implants, 87; and combinations of direct and indirect
procedures, 32. Reoperations performed were single bypass, 141 patients;
double, 61; and triple or other coronary artery operations, 17. Eight
patients died within 30 days of operation (3.7 per cent). Major
postoperative complications included hepatitis, 24 (11 per cent);
myocardial infarction, 19 (9 per cent); bleeding, 21 (10 per cent); and
respiratory insufficiency, 12 (5 per cent). Follow- up for 202 long-term
survivors was complete (mean 29 months). In patients who originally
underwent direct revascularization, Class I or II (N.Y.H.A.) was attained
in 35 of 43 (81 per cent) of those reoperated upon for primary graft
failure, in 14 of 15 (93 per cent) of those with progressive
atherosclerosis, and in 27 of 33 (82 per cent) of patients with combined
indications. Arteriography was performed after the reoperation in 55
patients (mean interval 17 months), and 65 of 77 (84 per cent) grafts were
patent. Nineteen of 22 grafts performed for primary graft failure were
patent. We have made the following conclusions: (1) Reoperation for direct
myocardial revascularization can be accomplished with low mortality rates
although morbidity is high; (2) complete relief of symptoms was achieved in
65 per cent of survivors; (3) results in patients reoperated upon for graft
failure alone were similar to results in those operated upon for
progressive atherosclerosis or combined indications; and (4) high graft
patency was found in secondary grafts constructed to arteries involved with
primary graft failure.
