Reoperative coronary surgery with and without cardiopulmonary bypass

Background. Reoperative coronary surgery without cardiopulmonary bypass (CP B) was analyzed to evaluate the technical profile of the patients studied a nd the benefit from this technique. Material and Methods: From November 21, 1994. to May 20, 1999, 166 patients had reoperative coronary surgery, 112 patients (Group A) with and 54 patients (Group B) without CPB.,Median stern otomy was used in all the patients in Group A and in 13 patients in Group B . The remaining had a LAST (37 patients) or-a posterolateral thoracotomy (4 patients). Results: Anastomoses per patient were 2.4 +/- 0.8 in Group A an d 1.1 +/- 0.4 in Group B (p < 0.001). When a single. graft was needed, CPB was not used in 82.8% of the cases. However, when more than one graft was r equired, CPB was not used in only 5.6% of the cases. When a single territor y had to be grafted, CPB was not used in 76.6% of the patients. If two terr itories were grafted, only 6.8% of the patients were in Group B, whereas no patient who needed a graft in all the three territories was in Group B. Ov erall mortality was 3.6% cerebrovascular accident. (CVA) and acute myocardi al infarction (AMI) incidence were 0.6% and 1.8%, respectively, and were si milar in both groups. Incidence of early-major events (overall 8.4%) was no t different between groups. Conclusions: The primary endpoints (mortality, CVA rate, and AMI) were similar in both groups, but patients in Group 13 we re less complicated. However, patients in the two groups were not the same, as the technical profile was quite different. As our results were similar to those obtained in the first operation, we think that consideration of,di fferent surgical possibilities, depending on territory to be grafted, will improve the results of redo coronary surgery, making them similar to those obtained in the first operation.