The Journal of Thoracic and Cardiovascular Surgery, Vol 77, 889-895, Copyright © 1979 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Angina following myocardial revascularization. Does time of recurrence predict etiology and influence results of operation?
AT Culliford, RW Girdwood, OW Isom, KR Krauss and FC Spencer
To assess the operative mortality and long-term results in patients
undergoing repeat revascularization for recurrent angina, we analyzed 48
consecutive patients operated upon at New York University Medical Center
between 1970 and 1978. Between January, 1970, and July, 1973, 15 patients
underwent repeat revascularization with five operative deaths (33 percent).
Thirty-three patients underwent similar operations from July, 1973, to
July, 1978, with only one operative death (3 percent). Technical factors
and improved methods of myocardial protection during the operation directly
influence this decrease in operative mortality rate. The indication for
reoperation was incapacitating angina developing within 2 months of the
inital operation in 18 patients (early failures) and after more than 2
months in 30 patients (late failures). The early failures were most
commonly attributed to technical factors (33 percent) and graft occlusion
by exuberant pericardial scarring (33 percent). The late failures were
commonly related to the development of new native coronary lesions (47
percent) and selection of an incorrect site for distal anastomoses (23
percent). The prognostic and therapeutic implications of these findings
will be discussed in detail. Angina was abolished or significantly
decreased in 90 percent of the survivors, and there were only two late
deaths occuring 18 and 20 months postoperatively. These data indicate that
patients undergoing repeat myocardial revascularization can be operated
upon with low operative mortality rates and symptomatic improvement
comparable to that of patients undergoing coronary artery bypass for the
first time.
