IN-HOSPITAL AND LONG-TERM OUTCOME AFTER REOPERATIVE CORONARY-ARTERY BYPASS GRAFT-SURGERY

Background Increasingly over the past several years, patients have ret urned after coronary-surgery for reoperative procedures, and the exper ience has become substantial. In this report, we describe immediate- a nd long-term outcomes after reoperative coronary artery bypass graft s urgery. Methods and Results The source of data was the clinical databa se at Emery University. The surgical procedure and statistical methods were standard. Data were collected prospectively and entered into a c omputerized database. Followup was by letter, telephone, or hospital r ecords documenting additional events resulting in readmission. In-hosp ital correlates of survival were determined by logistic regression, an d long-term correlates were determined by Cox model analysis. There we re 2030 patients with a mean age of 61 and a mean of 7.8+/-4.1 years s ince the first surgery. The mean ejection fraction was close to 50%, a nd the majority had three-vessel or left main disease. Urgent or emerg ency surgery was required in 16.6%. The internal mammary was used in 6 0.1%. Q-wave myocardial infarctions occurred in just over 5%. Neurolog ical events increased from 1.2% at less than age 50 to 4.1% at more th an age 70. The hospital mortality increased from 5.7% at less than age 50 to 10%, at more than age 70, with an overall rate of 7.0%. Mortali ty was 5.7% for elective, 10.9% for urgent, and 16.4% for emergency ea ses. Angina was noted at follow-up in 41.3%. Urgent or emergency surge ry, reduced ejection fraction, hypertension, older age, and female sex were univariate and multivariate correlates of in-hospital death. Dia betes was a univariate correlate only. Five- and 10-year survival rate s were 76% and 55%, respectively. Five- and 10-year myocardial infarct ion-free survival rates were 63% and 40%, respectively. By 12 years, f ew patients were free of cardiac events, The univariate and multivaria te correlates of long-term mortality were older age, reduced ejection fraction, hypertension, diseased vessels, presence of diabetes, conges tive failure, and emergency surgery, with a strong trend for female se x. The use of the internal mammary artery was not a correlate for long -term mortality. Conclusions Patients undergoing reoperative procedure s have higher mortality initially and at long term than patients under going a first procedure. Expected mortality based on covariates may he lp in the decision of whether to perform reoperative coronary artery b ypass graft surgery.