Coronary reoperations: Recurrence of angina and clinical outcome with and without cardiopulmonary bypass

被引:21
作者
Czerny, M [1 ]
Zimpfer, D [1 ]
Kilo, J [1 ]
Gottardi, R [1 ]
Dunkler, D [1 ]
Wolner, E [1 ]
Grimm, M [1 ]
机构
[1] Univ Vienna, Sch Med, Dept Cardiothorac Surg, A-1090 Vienna, Austria
关键词
D O I
10.1016/S0003-4975(02)04652-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. We compared our experience of minimal tissue dissection and target vessel revascularization without cardiopulmonary bypass (CPB) with the standard procedure of total dissection of the heart and complete revascularization with CPB in patients who had elective reoperative coronary artery bypass grafting (redo-CABG). Methods. We analyzed recurrence of angina and clinical outcome in 118 patients who had elective redo-CABG between January 1995 and April 2002. Seventy-four patients had redo-CABG with CPB, and 44 patients had redo-CABG without CPB. Results. Perioperative outcome was comparable with regard to morbidity and mortality rates. At follow-up, the mean Canadian Cardiovascular Society score was 1.3 +/- 0.6 in patients who had redo-CABG with CPB and 1.7 +/- 0.8 in patients who had redo-CABG without CPB (p = 0.02). At follow-up, patients who had redo-CABG with out CPB had a higher rate of recurrence of angina (log rank = 0.001) and higher use of nitrates (p = 0.015). Target vessel revascularization was an independent predictor of recurrence of angina in younger patients (< 75 years; p = 0.012) but not in the elderly ( greater than or equal to75 years; p = 0.142). Conclusions. In elective redo-CABG patients, minimal tissue dissection and target vessel revascularization without cardiopulmonary bypass did not add significant benefit with regard to perioperative morbidity and mortality. The unsatisfactory relief of symptoms does not seem to justify target vessel revascularization by a less invasive approach. Therefore, this technique should be offered exclusively to patients at high risk with complete revascularization using CPB, such as the elderly. (C) 2003 by The Society of Thoracic Surgeons.
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页码:847 / 852
页数:6
相关论文
共 29 条
[1]   Transmyocardial laser revascularization: Early results and 1-year follow-up [J].
Agarwal, R ;
Ajit, M ;
Kurian, VM ;
Rajan, S ;
Arumugam, SB ;
Cherian, KM .
ANNALS OF THORACIC SURGERY, 1999, 67 (02) :432-436
[2]   Minimally invasive versus conventional reoperative coronary artery bypass [J].
Allen, KB ;
Matheny, RG ;
Robison, RJ ;
Heimansohn, DA ;
Shaar, CJ .
ANNALS OF THORACIC SURGERY, 1997, 64 (03) :616-622
[3]   Re-do cardiac surgery in patients over 70 years old [J].
Awad, WI ;
DeSouza, AC ;
Magee, PG ;
Walesby, RK ;
Wright, JE ;
Uppal, R .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 1997, 12 (01) :40-45
[4]   EFFECT OF COMPLETENESS OF REVASCULARIZATION ON LONG-TERM OUTCOME OF PATIENTS WITH 3-VESSEL DISEASE UNDERGOING CORONARY-ARTERY BYPASS-SURGERY - A REPORT FROM THE CORONARY-ARTERY SURGERY STUDY (CASS) REGISTRY [J].
BELL, MR ;
GERSH, BJ ;
SCHAFF, HV ;
HOLMES, DR ;
FISHER, LD ;
ALDERMAN, EL ;
MYERS, WO ;
PARSONS, LS ;
REEDER, GS .
CIRCULATION, 1992, 86 (02) :446-457
[5]   Elimination of cardiopulmonary bypass: a prime goal in reoperative coronary artery bypass surgery [J].
Bergsland, J ;
Hasnain, S ;
Lajos, TZ ;
Salerno, TA .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 1998, 14 (01) :59-62
[6]   Reoperative coronary bypass surgery: Effect of patent grafts and retrograde cardioplegia [J].
Borger, MA ;
Rao, V ;
Weisel, RD ;
Floh, AA ;
Cohen, G ;
Feindel, CM ;
Scully, HE ;
Mickleborough, LL ;
Yau, TM .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2001, 121 (01) :83-90
[7]  
BUDA AJ, 1981, J THORAC CARDIOV SUR, V82, P383
[8]   Reoperative coronary artery bypass procedures: Risk factors for early mortality and late survival [J].
Christenson, JT ;
Schmuziger, M ;
Simonet, F .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 1997, 11 (01) :129-133
[9]  
COSGROVE DM, 1984, J THORAC CARDIOV SUR, V88, P673
[10]   Systemic inflammatory response syndrome after cardiac operations [J].
Cremer, J ;
Martin, M ;
Redl, H ;
Bahrami, S ;
Abraham, C ;
Graeter, T ;
Haverich, A ;
Schlag, G ;
Borst, HG .
ANNALS OF THORACIC SURGERY, 1996, 61 (06) :1714-1720