REOPERATIVE CORONARY GRAFTING - CHANGING PATIENT PROFILES, OPERATIVE INDICATIONS, TECHNIQUES, AND RESULTS

To assess the changing trends in patient profiles, operative indicatio ns and techniques, and their impact on the results of reoperative myoc ardial revascularization, we reviewed the records of 750 consecutive p atients who had an isolated first reoperation for coronary artery dise ase at the Massachusetts General Hospital from 1977 to 1992. The patie nts were chronologically grouped into three equal cohorts of 250 patie nts. Our assessment over time revealed a significantly (p < 0.03) incr eased incidence of the following: older age, peripheral vascular disea se, grafts at the first revascularization, longer operative interval, interval infarctions and angioplasties, and congestive heart failure a nd unstable angina requiring greater use of preoperative intraaortic b alloon pumping. At catheterization significantly more left main corona ry disease, lower ejection fractions, and more patent but diseased gra fts were found. The reoperations were significantly done more urgently , with more grafts placed and a greater use of mammary artery grafting . Despite these increased risks over time, median postoperative hospit al stay was significantly shortened (p < 0.001), though hospital morta lity (5.3%) and perioperative myocardial infarction (6.3%) did not cha nge significantly. Significant multivariate predictors of hospital dea th were nonelective operation, perioperative myocardial infarction, pr ior myocardial infarction, and mammary artery grafting at the initial operation.