CORONARY-BYPASS REOPERATIONS WITHOUT CARDIOPULMONARY BYPASS - THE ISRAELI EXPERIENCE

Objectives. To evaluate results of coronary artery bypass grafting (CA BG) reoperations without cardiopulmonary by-pass (CPB). Materials and methods. Thirty-two patients underwent CABG reoperation with CPB betwe en December 1991 and December 1993. There were 29 (91%) males, and 3 ( 9%) females. Mean age was 62 +/- 7 years. Five (16%) were operated on emergently, two (6%) of them during cardiogenic shock. Three (9%) were referred for operation up to two weeks following acute MI. Six (19%) had preoperative EF <35%. Significant associated systemic diseases inc luded previous CVA in two patients (6%), calcified aorta in two (6%), peripheral vascular disease in six (19%), renal failure in one (3%), a nd severe COPD in one (3%). Mean number of grafts/pt was 1.5 (range 1- 3), and IMA was used in 26 (81%) of patients. Only nine patients (28%) received a graft to a circumflex marginal artery, six (66%) of whom w ere operated on through left thoracotomy. Results. Only two patients ( 6%) had low output syndrome postoperatively; one was supported with ca techolamines, and the other with intraaortic balloon pump. Hospital st ay was 6.1 +/- 1.5 days (mean+/-SD). Early unfavorable outcome include d operative death in one patient (3.1%), non-fatal. MI in two (6%), an d sternal infection in one (3%). Follow-up (10+/-5 months, mean+/-SD) showed two late deaths (one cardiac, and one carcinoma), one (3%) non- fatal MT, and return of angina in three (9%) patients. Conclusions. CA BG reoperations without CPB should be considered, particularly for rev ascularization of the LAD and RCA systems. Left thoracotomy is optiona l for patients with disease confined to circumflex and LAD systems.