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DOI: 10.1055/s-0041-1725742
Redo Coronary Artery Bypass Grafting in 416 Patients: An Individualized Approach Evolving Over Time
Objectives: Coronary artery bypass grafting (CABG) is the revascularization strategy of choice for patients with multivessel coronary artery disease, especially for those with complex lesions and high SYNTAX scores, diabetes mellitus, and those with left ventricular systolic dysfunction. Approximately 10 to 20% of patients undergoing CABG require repeat revascularization. The best operational approach remains a challenge, especially regarding the best way for cardioplegia and the revascularization technique used.
Methods: We retrospectively investigated our operational approaches and outcome of our patients receiving redo-coronary artery revascularization. We retrospectively analyzed all patients with redo-coronary artery revascularization from 2000 to 2015. A total of 416 patients were included.
Result: 82.8% were male, aged 68.4 ± 8.04, with 51.2% patients above the age of 70 years. Mean EuroSCORE was 9.46 (± 9.54). 147 patients (35.2%) had previous PCI. Most cases (86.6%) were elective, with 13.4% urgent cases. Left ventricular function was good in 59.8% of cases, moderate in 34.4% and poor in 5.3% of cases. Operation times, cardiopulmonary bypass times and clamp times were 257.6 (± 78.22 minutes), 120.2 (± 52.2 minutes) and 44.3 (± 25.4 minutes), respectively. 9.3% of patients were operated beating heart without clamping of the aorta. Patients received 2.59 (± 0.944) peripheral anastomoses. Myocardial infarction, low cardiac output, neurological complications and intra-hospital death were 5.5, 11.2, 2.6, and 5.7%, respectively. Outcome and complications (including postoperative CK-MB levels) were independent from the used cardioplegia (antegrade/retrograde). Preoperative risk factors for mortality were EuroSCORE, diabetes, and urgency of operation.
Conclusion: Redo coronary artery revascularizations are challenging, however, mortality well below the predicted EuroSCORE can be achieved. The different techniques (including used grafts and cardioplegia/beating heart) have no significant effect on the postoperative outcome. Therefore, redo CABG remains a highly challenging approach, demanding the surgeon's full armament of techniques for revascularization, individualized for each patient.
Publication History
Article published online:
19 February 2021
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