CONTINUOUS RETROGRADE CARDIAC PERFUSION DECREASES RISK OF REOPERATIVECORONARY-ARTERY BYPASS-GRAFTING

Embolization of atheromatous debris from old saphenous vein grafts is a major factor that increases the risk of reoperative coronary artery bypass grafting (CABG) when compared with primary CABG. To decrease th is risk, a technique consisting of minimal dissection of the heart pri or to cross clamping, continuous retrograde coronary sinus perfusion w ith 32 degrees C blood, and temporary posterior cardiac interventricul ar vein occlusion, during which time all dissection and anastomoses ar e performed, was evaluated prospectively in 130 consecutive patients f rom January 2, 1991, through February 28, 1995. This group was compare d with a cohort of 1107 patients undergoing primary CABG performed con currently. The two groups were similar in age (median sixty-eight year s), incidence of hypercholesterolemia, peripheral vascular disease, sm oking history, and left main stem stenosis. More patients undergoing r eoperative CABG had previous myocardial infarctions (61.5% vs 54.5%), a higher incidence of triple-vessel coronary artery disease (89.2% vs 77.1%, P=0.002), and a lower ejection fraction (54.0% vs 56.9%). The m edian interval from primary CABG to reoperative CABG was one hundred t wenty-seven months with a range of 2.5 to two hundred seventy-nine mon ths. The cross clamp time (median one hundred three vs sixty-nine minu tes, P=0.000001) and perfusion time (median one hundred thirty-four vs ninety-four minutes, P=0.000001) were significantly higher in the reo perative CABG group. The requirements for inotropic support postoperat ively, perioperative myocardial infarction (1.5% vs 2.4%, P=0.397), an d mortality (3.1% vs 3.4%, P=0.54) were statistically equivalent in th e two groups. These data reveal that continuous retrograde coronary si nus perfusion, posterior cardiac interventricular vein occlusion, and single cross-clamping technique improve outcomes of reoperative CABG t o that approaching primary CABG.