TY - JOUR
T1 - Reoperation for Coronary Artery Bypass Grafting Surgery
T2 - Outcomes and Considerations for Expanding Interventional Procedures
AU - Maltais, Simon
AU - Widmer, Robert J.
AU - Bell, Malcolm R.
AU - Daly, Richard C.
AU - Dearani, Joseph A.
AU - Greason, Kevin L.
AU - Joyce, David L.
AU - Joyce, Lyle D.
AU - Schaff, Hartzell V.
AU - Stulak, John M.
N1 - Publisher Copyright:
© 2017 The Society of Thoracic Surgeons
PY - 2017/6
Y1 - 2017/6
N2 - Background Owing to an inevitable degeneration of grafts over time, patients may require consideration for repeat coronary artery bypass graft (CABG) surgery. As our understanding of preoperative risks associated with redo CABG surgery is limited and availability of data is limited to historical cohorts, we sought to evaluate our contemporary 20-year experience with this challenging patient population. Methods Between January 1993 and June 2014, 748 patients underwent redo CABG surgery at our institution. Median age at reoperation was 69 years (range, 36 to 88), and 644 (86%) were male. Median follow-up was 15.1 years and was 100% complete. Preoperatively, 191 patients (26%) had diabetes mellitus, 562 (75%) had hypertension, 206 (28%) had peripheral vascular disease with 121 (16%) having a history of cerebrovascular disease, and 459 (61%) had prior myocardial infarction. Number of prior CABG operations was 1 in 682 patients (91%), 2 in 62 patients (8%), and 3 in 4 patients (1%). Results All patients underwent isolated redo CABG surgery; all 748 (100%) procedures were performed using cardiopulmonary bypass, with median time on pump of 95 minutes (maximum, 378) and cross-clamp time of 48 minutes (maximum, 176). There were 47 early deaths (6%); early nonfatal morbidity included renal failure in 51 patients (7%), stroke in 15 (2%), and pneumonia in 22 (3%). Overall 1-, 5-, and 10-year survival was 89%, 77%, and 51%, respectively. Age (hazard ratio [HR] 1.74, p < 0.001), diabetes (HR 1.51, p < 0.001), peripheral vascular disease (HR 1.51, p < 0.001), and end-stage renal disease with dialysis (HR 11.85, p < 0.001) were associated with increased long-term mortality, whereas higher left ventricular ejection fraction (per 10% increase) was protective (HR 0.78, p < 0.001). Conclusions Redo CABG can be performed safely with low early and late morbidity and mortality. Important predictors of long-term mortality such as age, diabetes, renal disease, and peripheral vascular disease were identified and should guide the treatment strategy chosen for this challenging group of patients.
AB - Background Owing to an inevitable degeneration of grafts over time, patients may require consideration for repeat coronary artery bypass graft (CABG) surgery. As our understanding of preoperative risks associated with redo CABG surgery is limited and availability of data is limited to historical cohorts, we sought to evaluate our contemporary 20-year experience with this challenging patient population. Methods Between January 1993 and June 2014, 748 patients underwent redo CABG surgery at our institution. Median age at reoperation was 69 years (range, 36 to 88), and 644 (86%) were male. Median follow-up was 15.1 years and was 100% complete. Preoperatively, 191 patients (26%) had diabetes mellitus, 562 (75%) had hypertension, 206 (28%) had peripheral vascular disease with 121 (16%) having a history of cerebrovascular disease, and 459 (61%) had prior myocardial infarction. Number of prior CABG operations was 1 in 682 patients (91%), 2 in 62 patients (8%), and 3 in 4 patients (1%). Results All patients underwent isolated redo CABG surgery; all 748 (100%) procedures were performed using cardiopulmonary bypass, with median time on pump of 95 minutes (maximum, 378) and cross-clamp time of 48 minutes (maximum, 176). There were 47 early deaths (6%); early nonfatal morbidity included renal failure in 51 patients (7%), stroke in 15 (2%), and pneumonia in 22 (3%). Overall 1-, 5-, and 10-year survival was 89%, 77%, and 51%, respectively. Age (hazard ratio [HR] 1.74, p < 0.001), diabetes (HR 1.51, p < 0.001), peripheral vascular disease (HR 1.51, p < 0.001), and end-stage renal disease with dialysis (HR 11.85, p < 0.001) were associated with increased long-term mortality, whereas higher left ventricular ejection fraction (per 10% increase) was protective (HR 0.78, p < 0.001). Conclusions Redo CABG can be performed safely with low early and late morbidity and mortality. Important predictors of long-term mortality such as age, diabetes, renal disease, and peripheral vascular disease were identified and should guide the treatment strategy chosen for this challenging group of patients.
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U2 - 10.1016/j.athoracsur.2016.09.097
DO - 10.1016/j.athoracsur.2016.09.097
M3 - Article
C2 - 28012643
AN - SCOPUS:85008210606
SN - 0003-4975
VL - 103
SP - 1886
EP - 1892
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -