3RD-TIME CORONARY-ARTERY BYPASS OPERATIONS - SURGICAL STRATEGY AND RESULTS

Background. Increasingly, patients are returning for a second, third, and even fourth coronary artery bypass graft (CABG) procedure. Methods . This report reviews the in-hospital and long-term outcomes for 102 p atients undergoing a third or fourth CABG at Emery University from Dec ember 1977 to April 1994. Results. The mean interval from the first to second CABG was 5.2 +/- 3.5 years and from the second to the third CA BG 6.8 +/- 4.1 years. The mean age was 60 +/- 9 years, 91% were male, 33% had hypertension, 16% diabetes, 86% class III or IV angina (Canadi an Cardiovascular Society), 4.4% congestive failure (New York Heart As sociation), and 73% three-vessel disease. The in-hospital mortality ra te was 9.8%, with a perioperative myocardial infarction rate of 8.8% a nd a stroke rate of 1.9%. Conclusions. These perioperative mortality a nd myocardial infarction rates are several times higher than those rep orted for initial revascularizations or first-time redo CABG operation s. However, the 5- and 10-year survival rates of 79% and 59%, respecti vely, and a myocardial infarction-free survival of 62% at 5 years, the benefits of a third-time CABG procedure are apparent for this high-ri sk group of patients.