Comparison of Operative Mortality and Morbidity for Initial and Repeat Coronary Artery Bypass Grafting: The Coronary Artery Surgery Study (CASS) Registry Experience

Abstract

The National Heart, Lung, and Blood Institute's Coronary Artery Surgery Study (CASS) registry population was reviewed to allow comparison of operative mortality and morbidity rates for initial and repeat coronary artery bypass grafting (CABG) procedures. Standardized data collection was employed in CASS during patient entry (July 1, 1974, to May 31, 1979) and follow-up (ended November 30, 1982). Initial CABG was performed on 9,369 patients. Mean follow-up was 60.5 months. Repeat CABG was required in 283 patients (3.0%). The mean interval between operations was 39.3 months. Individuals needing reoperation tended to be young ( p < 0.0001) and female ( p < 0.002) and to have less extensive coronary artery disease ( p ≤ 0.0001), less left ventricular impairment ( p < 0.0001), less evidence of congestive heart failure ( p = 0.006), and fewer coronary vessel systems bypassed at the first operation ( p < 0.0001). Repeat CABG carried an increased risk of death compared with initial CABG (5.3% versus 3.1%, respectively; p < 0.05). However, the rates of perioperative myocardial infarction (6.4% for repeat and 5.8% for initial CABG) and of all surgical complications combined (30.6% versus 27.9%) were not significantly different from those at initial CABG.