A RETROSPECTIVE STUDY OF 184 CORONARY REOPERATIONS - INDICATIONS, TECHNIQUES AND POSTOPERATIVE PROGNOSIS

The authors performed 184 coronary reoperations (172 redux, 12 tridux) between January 1986 and december 1995 in 177 patients (165 men, 12 w omen) with an average age at surgery of 62.9 +/- 7.6 years. The averag e interval between the surgical procedures was 9.5 +/- 4.5 years. The symptoms were recurrent angina, stable in 44%, unstable in 51%, and ca r. diac failure, 7%. Graft dysfunction was the cause in 94.5% of cases with progression of atheroma of the native coronary vessels in only 5 .6% of cases. At reoperation 389 bypass procedures were performed (ven ous 39.5%, arterial 60.5%) (2.1 +/- 0.6 per patient) with 10 associate d procedures (3 mitral valvuloplasties, 2 left ventricular aneurysmect omy, 3 aortic valve replacements, 1 replacement of the ascending aorta , 1 carotid endarteriectomy). The operative mortality was 10.9%. The c auses of the 20 deaths were myocardial infarction (7), left ventricula r failure (8), arrhythmias (2), mediastinitis (1) and multi-organ fail ure (2). The risk factors for death were : the date of surgery (19% be fore 1991 and 8% after : p = 0.03), age (18% after 60 years, 2% before : p= 0.015), the interval between the surgical procedures (33% after 15 years, p= 0.02), anterograde cardioplegic injection alone (15% vers us 4.5% when mixed antero and retrograde perfusion was used : p= 0.02) . The morbidity was 28% (52/184 patients); 132 patients (72%) had unco mplicated postoperative courses. The incidence of repeat coronary arte ry surgery is in constant progression. Improved medico-surgical manage ment should continue to reduce the mortality which is still high.