PMID- 7820526
OWN - NLM
STAT- MEDLINE
DCOM- 19950216
LR  - 20071115
IS  - 0967-2109 (Print)
IS  - 0967-2109 (Linking)
VI  - 2
IP  - 5
DP  - 1994 Oct
TI  - Reoperative myocardial revascularization: an analysis of 458 reoperations and 
      2645 single operations.
PG  - 623-9
AB  - A consecutive series of 2645 patients underwent primary coronary bypass grafting 
      while 458 patients underwent reoperative bypass during a 9-year period. The mean 
      age (61 years), sex distribution (83% men) and preoperative risk factors were 
      identical in the two groups. Significantly more patients belonged to New York 
      Heart Association (NYHA) class 4 and were clinically unstable in the reoperative 
      group (P < 0.001). The internal mammary artery was used in 43% of the single 
      operation group but in only 23% of patients who subsequently required reoperation 
      (P < 0.001). In reoperations 61% of the patients had an internal mammary artery 
      graft (P < 0.001). The overall operative mortality rate for single operation was 
      2.3% (62/2645) versus 9.2% (42/458) for reoperations. Patients with a reoperative 
      interval of more than 1 year had a 8.4% mortality rate, compared with 28% in 
      those reoperated on 1 year or less after the initial operation (P < 0.01). 
      Preoperative myocardial infarction, intra-aortic balloon pump insertion, 
      prolonged ventilatory support and ventricular arrhythmias were all prevalent 
      after reoperations (all P > 0.001), while postoperative myocardial infarctions 
      and re-sternotomy for bleeding did not differ between the groups. Emergency 
      operation, preoperative NYHA class 3-4 and poor left ventricular function were 
      predictors of perioperative mortality in both groups. Left main stem stenosis was 
      an added factor in the reoperative group. After reoperation 93% of the hospital 
      survivors were alive at 5 years after surgery; the cardiac event-free rate was 
      59% and > 90% of the patients showed improvement of their NYHA class during the 
      follow-up. Reoperative coronary artery bypass grafting is effective, but has an 
      increased operative mortality and morbidity, especially in patients with unstable 
      angina, left main stem stenosis and poor preoperative left ventricular function.
FAU - Schmuziger, M
AU  - Schmuziger M
AD  - Cardiovascular Unit, Hopital de la Tour, Geneva, Switzerland.
FAU - Christenson, J T
AU  - Christenson JT
FAU - Maurice, J
AU  - Maurice J
FAU - Mosimann, E
AU  - Mosimann E
FAU - Simonet, F
AU  - Simonet F
FAU - Velebit, V
AU  - Velebit V
LA  - eng
PT  - Journal Article
PL  - England
TA  - Cardiovasc Surg
JT  - Cardiovascular surgery (London, England)
JID - 9308765
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Angina, Unstable/epidemiology
MH  - Arrhythmias, Cardiac/epidemiology
MH  - Coronary Artery Bypass/adverse effects/mortality/*statistics & numerical data
MH  - Coronary Disease/epidemiology
MH  - Emergencies
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Internal Mammary-Coronary Artery Anastomosis/adverse effects/mortality/statistics 
      & numerical data
MH  - Intra-Aortic Balloon Pumping/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/epidemiology
MH  - Prevalence
MH  - Reoperation/adverse effects/mortality/statistics & numerical data
MH  - Respiration, Artificial/statistics & numerical data
MH  - Risk Factors
MH  - Sternum/surgery
MH  - Survival Rate
MH  - Switzerland/epidemiology
MH  - Thoracotomy/statistics & numerical data
MH  - Ventricular Function, Left
EDAT- 1994/10/01 00:00
MHDA- 1994/10/01 00:01
CRDT- 1994/10/01 00:00
PHST- 1994/10/01 00:00 [pubmed]
PHST- 1994/10/01 00:01 [medline]
PHST- 1994/10/01 00:00 [entrez]
PST - ppublish
SO  - Cardiovasc Surg. 1994 Oct;2(5):623-9.