MORBIDITY AND MORTALITY IN 200 CONSECUTIVE CORONARY REOPERATIONS

Objective: The morbidity and mortality of coronary reoperations is sti ll higher than in primary myocardial revascularization. In the present paper we analyzed the relation between several preoperative and perop erative variables and the perioperative morbidity and mortality of cor onary reoperations. Methods: The data of 200 consecutive patients unde rgoing isolated aortocoronary bypass reoperation were studied by univa riate and multivariate analysis. The mean age was 59 years (range 44-8 3 years), 163 (81%) patients were male and 37 (19%) female. The overal l hospital mortality was 8.5% (17/200), and in 32/200 patients (16%) a perioperative myocardial infarction was noted. Results: By univariate analysis, a myocardial infarction before the initial operation and a myocardial infarction between the initial operation and the reoperatio n, peripheral vascular disease, diabetes, anginal status and periopera tive myocardial infarction were identified as factors influencing the operative mortality. Multivariate analysis identified perioperative my ocardial infarction and anginal status as predictors of hospital morta lity. Further analysis identified peripheral vascular disease, diabete s, delivery way (ante/retrograde) of cardioplegic solution, and angina l status as univariate predictors of perioperative myocardial infarcti on. The only significant multivariate predictor of perioperative myoca rdial infarction was the anginal status. Conclusion: The anginal statu s (New York Heart Association greater than or equal to IV-A) is the do minant variable in predicting the operative outcome in coronary reoper ations, and a decrease of the operative mortality and perioperative in farction rate can be expected by avoiding 'so called' emergency reoper ations. (C) 1997 Elsevier Science B.V.