Predictive variables in reoperation for coronary artery disease

Abstract

Seventy-one consecutive patients undergoing reoperation for coronary artery disease (1968 to 1976) were evaluated. Clinical indication for reoperation was recurrent angina pectoris in all patients. The cause of recurrent symptoms was related to occlusion of previously placed bypass grafts in 59 patients (83 percent) and to progressive atherosclerosis or the presence of previously unbypassed lesions in 12 patients (17 percent). Complete follow-up (mean 2.2 years) demonstrated symptomatic improvement in 42 patients (59 percent); 19 patients (27 percent) were relieved of angina entirely. Two patients (2.8 percent) died in the perioperative period. Technical problems anticipated with reoperation, such as inability to identify target vessels and excessive bleeding, were not encountered. Preoperative clinical status and coronary anatomic data, including the distribution of coronary disease, individual vessel size and degree of atherosclerotic involvement, indication for reoperation, and the completeness of the initial revascularization procedure, were analyzed and correlated with postoperative clinical status. Favorable coronary anatomy, defined as adequate vessel size (≥2.0 mm.) and a proximal distribution of atherosclerotic involvement, was the one factor which showed a significant correlation (p < 0.05) with improved clinical status. Prior postcardiotomy syndrome and prior infarction in two myocardial sites showed a significant correlation (p < 0.05) with unimproved clinical status. Our findings suggest that reoperation can be accomplished with low morbidity and mortality rates and that there is the potential for therapeutic benefit in the majority of cases.