The Journal of Thoracic and Cardiovascular Surgery, Vol 75, 499-504, Copyright © 1978 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Reoperation in symptomatic patients after direct coronary artery revascularization
AH Krause Jr, US Page, JC Bigelow, JE Okies and SF Dunlap
Seventy-nine patients underwent 85 reoperations to revascularize the
myocardium at intervals from 2 days to 5 years (mean 13 months) after
primary direct revascularization procedures. A total of 122 bypass grafts
including 43 individual veins, 43 double or triple sequential veins, and 17
internal mammary arteries (IMA) were utilized. Failure of previous bypass
grafting was the most common reason for recurrent symptoms, partially due
to the high failure rate of radial artery segments used as bypass conduits.
One operative and three late deaths have occurred. Coronary arteriography,
performed after reoperation (mean 14 months) in 15 patients, revealed a
graft patency rate of 68 percent. Significant differences in postoperative
complications between the first and subsequent operation could not be
demonstrated. Combined nonfatal perioperative infarctions with the first
and subsequent operations decreased ventricular function and probably
contributed to the improved symptomatic state of some patients. It is
concluded that good symptomatic relief and long-term survival can be
achieved by reoperation in selected patients who have recurrent symptoms
after primary direct myocardial revascularization.
