CORONARY-ARTERY REOPERATIONS - INDICATION S AND RESULTS

The aim of this study was to assess the results of coronary reoperatio ns and to determine the indications. Between January 1972 and December 1990, 166 coronary reoperations were performed in 161 patients (5 pat ients were operated three times). The interval between the first and s econd operation was 93 +/- 46 months. The interval between recurrence of symptoms and reoperation was 27 +/- 40 months. Recurrence of sympto ms was related to isolated problems with the bypass grafts in 23 % of cases, to an aggravation of the coronary disease without problems with the bypass grafts in 17 % of cases and to an association of the two c onditions in 60 % of cases. Mortality in the first 30 postoperative da ys was 7.8 % (13/161). The predictive factors of mortality were age ov er 70 years and an interval between recurrence of symptoms and reopera tion of over 12 months. The causes of death were myocardial infarction (n = 5), left ventricular failure (n = 4), sudden death (n = 3), and arrhythmias (n = 1). The average follow-up period of survivors (n = 13 4) was 40 +/- 32 months. Four patients have been transplanted. Seven p atients died secondarily. The cause of death was cardiac in 4 cases an d non-cardiac in 3 cases. The actuarial 5 year and 10 year survival ra tes were 85 +/- 3 %. Actuarial absence of myocardial infarction, angin a, Class III-IV cardiac failure and transplantation was 87 +/- 4 % at 5 years and 69 +/- 10 % at 10 years. These figures show that coronary reoperation gives good functional results and long-term survival. The results could be improved by reassessing patients as soon as symptoms recur and referring them rapidly to centres of interventional cardiolo gy or cardiac surgery.