Jt. Christenson et M. Schmuziger, 3RD-TIME CORONARY-BYPASS OPERATION - ANALYSIS OF SELECTION MECHANISMS, RESULTS AND LONG-TERM FOLLOW-UP, European journal of cardio-thoracic surgery, 8(9), 1994, pp. 500-504
Twenty-six patients underwent a third coronary artery revascularizatio
n between 1984 and 1993 at Hopital de la Tour, Geneva, Switzerland. Th
ese patients represent 5.4% of coronary artery bypass graft (CABG) reo
perations and 0.8% of the total CABG operations (3129) during the same
time period. There were 23 men (85%), the mean age was 57.2 years (ra
nge 33-71), 18 patients (69%) had 3-vessel disease and the mean left v
entricular ejection fraction (LVEF) was 59% (range 32-83%). The reason
for the third operation was graft failure in 62% of the cases. Twenty
-five patients (96%) were in Canadian Cardiovascular Society (CCS) cla
ss 3 or 4 preoperatively. Direct myocardial revascularization was perf
ormed in all patients with a mean of 3.2 grafts per patient (range 1-6
). Thromboendarterectomy was performed in six patients (23%) and patch
was used in four (15%). The internal mammary artery (IMA) was utilize
d in 85% of the patients. In-hospital mortality was 11.5% (3 patients)
. Non-fatal perioperative myocardial infarction and re-exploration for
bleeding did not occur in this group of patients. Respiratory failure
necessitating prolonged ventilatory support occurred in five patients
(19.2%). Long-term follow-up was carried out for all 23 hospital surv
ivors. The mean follow-up time was 52 months. The 5-year actuarial sur
vival rate was 84.5% for the entire group and 95.7% for hospital survi
vors. The preoperative CCS functional class had significantly improved
at the end of the follow-up, P < 0.001. Our data suggests that a thir
d-time coronary revascularization can be justified, with gratifying op
erative success and good long-term clinical results.