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Item does not contain fulltext BACKGROUND: Identify risk factors associated with mortality following repeat coronary revascularization (redoCABG) within the first 6 months following surgery. METHODS: Five hundred forty-one redoCABG patients (1987 to 1998) were studied by univariant and multivariant analysis. Mortality was assessed at three different points: hospital mortality (A) (36/541, 6.7%); mortality at 6 months (C) (75/541, 13.9%); and outpatient perioperative mortality, which is a death occurring from the time of hospital discharge to 6 months postoperatively (B) (39/541, 7.2%). RESULTS: Diabetes, hypertension, peripheral vascular disease, renal insufficiency, lung disease, myocardial infarction (MI) before the first operation, MI between the first and redoCABG, lack of sinus rhythm, no IMA graft, acute/emergency operation, perfusion time, and perioperative MI were all identified as risk factors related to early mortality. MI before the first operation, antegrade cardioplegia, and the time period 1987 to 1992 all influenced hospital mortality (A). Diabetes, hypertension, renal insufficiency, lung disease, and valvular heart disease all influenced the outpatient mortality up to 6 months. Independent predictive factors for early mortality were: age more than 69 years; diabetes; vascular insufficiency; chronic lung disease; MI between first and redoCABG; no IMA-graft; acute preoperative MI; emergency operation; perfusion time; perioperative MI; and the time period 1987 to 1992. Risk factors for in-hospital death included MI between the first and redoCABG, cardiopulmonary bypass time, and the time period 1987 to 1992. Diabetes is an important risk factor during the outpatient perioperative phase. Emergency surgery and perioperative MI predict mortality regardless of the time period (A, B, or C). CONCLUSIONS: Early mortality after redoCABG is influenced by many variables during the first 6 months following surgery. Understanding these factors and their time course may better help to assess the true risk associated with reoperation for recurrent coronary insufficiency.

Objective: Analysis of short and long term results, clinical, functional and subjective status of patients, with a patent arterial graft, after coronary reoperation (RECABG). Methods: Perioperative and follow-up data of 71 patients, undergoing coronary reoperations (1987–8) were studied. A cross-sectional follow-up was conducted, functional evaluation by the Duke Activity Status Index (DASI), and patient's evaluation of his life situation were registered. Results: Perioperative mortality was 7%. Eleven patients died during follow-up. The 12-month and 60-month survival was 96% and 80%. Event-free survival was 86% and 51%. Family doctors declared that 55/66 (83%) had benefitted from the coronary reoperations. New York Heart Association decreased significantly from 3.4±0.5 preoperative versus 1.5±0.4 postoperative. The mean DASI was 38.06±10.42. At the moment of the cross-sectional follow-up, 45/55 patients (82%) declared to have benefitted from the coronary reoperations. Conclusion: Improvement in New York Heart Association-class, good postoperative functional capacity, and patients positive evaluation, justify coronary reoperations in patients with a patent internal mammary artery graft.

Contains fulltext : 57537.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Despite advances in cardiac surgery, the risk of reoperative coronary artery bypass surgery (RECABG) still exceeds those of a primary myocardial revascularization and also the late results are not so favourable. In this study, long-term cardiac survival is analyzed. METHODS: We analyzed long-term cardiac survival of 466 patients who survived the first 6 months after a RECABG between January 1987 and December 1998. Actuarial survival estimates were calculated and pre- and peroperative variables were analyzed to identify predictors of long-term cardiac related mortality. RESULTS: Mean follow-up was 7.7 +/- 3.8 years (1-17 years), and follow-up was 95.6% complete. One-year cardiac survival was 98.2%, 5-year: 91.0%, 10-year: 78.7% and 14-year survival 60.2%. Cardiac survival was only significantly superior for patients under 65 years of age at the moment of the RECABG. Impaired left ventricular function was identified as the only independent predictor of late cardiac-related mortality. CONCLUSION: The long-term survival in patients undergoing RECABG is acceptable. Once patients survived the first 6 postoperative months, advanced age (>65 years) is affecting long-term cardiac survival and impaired left ventricular function is the only independent predictor of late cardiac mortality.

Objectives: Construct a predictive model for early mortality in coronary reoperations (RECABG). Methods: Five hundred and forty one RECABG (1987–1998) were studied by univariate and multivariate analysis. Stepwise selective procedure ðp , 0:05Þ was used to identify a subset of variables with prognostic value for early mortality. This subset was used to calculate a prognostic score ‘S’ and a predicted probability ‘P’ for early mortality, P ¼ 1=1 1 e 2S . Sensitivity analysis was used for evaluation. Results: The best predictive variables for early mortality were diabetes, vascular-, lung-disease, a myocardial infarction between the primary and the RECABG, acute- and emergency operation and the operative period. The prognostic accuracy (receiver operating characteristics curve (ROC) area) was 80%. Observed probabilities compare well with the predicted probabilities, and patients were classified in low risk (5%), intermediate risk (15%), high risk (30%) and very high risk (40%). A predicted probability of $0.40 was used as cut-off point for the prognostic test. The specificity of this test was 97%, sensitivity 33%, predictive value of a positive test 63% and 90% for a negative test. Conclusions: The results show that individual patients presented for RECABG, can be stratified according to their early mortality risk. This information can be used to inform the patient, and also to discus the opportunity of the RECABG. q 2002 Elsevier Science B.V. All rights reserved.

Objective: To outline the changes of the patient population undergoing redo-coronary artery bypass surgery (RECABG). Methods: Preoperative data of 582 first RECABGs, January 1987‐June 2000 were analyzed. Group A: 1987‐1991 ðn ¼ 193Þ; group B: 1992‐1995 ðn ¼ 201Þ; and group C: 1996‐June 2000 ðn ¼ 188Þ. Results: These 582 RECABGs represent about 8.5% of the performed bypass surgeries during this period. Mean age ðP ¼ ,0:001Þ, percentage of patients with kidney disease ðP ¼ 0:001Þ, a preoperative PTCA ðP , 0:001Þ increased. Significant more elective operations ðP , 0:001Þ and lesser urgent operations ðP ¼ 0:001Þ were performed in group C. There is a significant different distribution of vessel disease over the three periods ðP ¼ 0:04Þ. Significant more patients had a patent IMA graft ðP , 0:001Þ. The angina-free period after CABG ðP , 0:001Þ, the time period between both operations ðP , 0:001Þ and the period between the new onset of angina and the RECABG ðP ¼ 0:012Þ increased significantly. Despite the importance of progression of atherosclerosis of any sort decrease significantly ðP , 0:001Þ over the whole study, there is a significant increase of patients reoperated for isolated progression of the disease in the native coronary arteries ðP , 0:001Þ in group C. The impact of late GF was not different for the total group ðP ¼ 0:82Þ, however, the percentage of RECABGs for isolated late GF increased significantly between group A and B ðP , 0:001Þ but there was a decrease from B to C, however, not significant ðP ¼ 0:067Þ. Conclusion: During the past few years there is a trend in RECABG of older patients, with more coexisting diseases. There are an increasing number of patients with patent arterial grafts, an increase of the event-free period after the CABG, the period between the CABG and RECABG and of the time period between the onset of new angina and the RECABG. Although the impact of atherosclerosis, as angiographic indication, decreased over the total group, there is the significant increase of the percentage of patients reoperated because of isolated progression of atherosclerosis in the native coronary arteries. q 2002 Elsevier Science B.V. All rights reserved.