Shapira I, Isakov A, Heller I, Topilsky M, Pines A
Post-Cardiac Surgery Follow-up Clinic, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Chest. 1999 Jun;115(6):1593-7. doi: 10.1378/chest.115.6.1593.
Coronary artery bypass grafting (CABG) reoperation is being performed with increasing frequency.
To determine the clinical outcome and the long-term results of a second CABG.
An 1100-bed urban university-affiliated hospital.
Retrieval of data on selected parameters from medical records before surgery and prospective follow-up afterwards.
We studied the outcomes of 498 consecutive patients who underwent CABG reoperation in our institution from January 1978 to December 1989 and who were followed postoperatively. Their perioperative mortality, morbidity, and long-term follow-up results were re-evaluated. The end points of the study were December 1997, 15 years of follow-up, or the patient's death.
The perioperative mortality rate was 3%. The cumulative survival rates were 90.1%, 74%, and 63.4% at the 5-year, 10-year, and 15-year follow-ups, respectively. The cardiac event-free survival rates were 91.5%, 83.4%, and 67.8% at the 5-year, 10-year, and 15-year follow-ups, respectively. The risk factors adversely affecting long-term survival were advanced age, hypertension, and a low left ventricular ejection fraction (LVEF).
The long-term results of cumulative survival and cardiac event-free survival in patients who underwent CABG reoperation are good. Although this reoperation is safe overall, advanced age, hypertension, and a decreased LVEF significantly increase the surgical risk.
冠状动脉旁路移植术（CABG）再次手术的实施频率日益增加。
确定二次CABG的临床结局和长期结果。
一家拥有1100张床位的城市大学附属医院。
从手术前病历中检索选定参数的数据，并在术后进行前瞻性随访。
我们研究了1978年1月至1989年12月在我院接受CABG再次手术且术后接受随访的498例连续患者的结局。对他们的围手术期死亡率、发病率和长期随访结果进行了重新评估。研究终点为1997年12月、15年随访或患者死亡。
围手术期死亡率为3%。5年、10年和15年随访时的累积生存率分别为90.1%、74%和63.4%。5年、10年和15年随访时无心脏事件生存率分别为91.5%、83.4%和67.8%。影响长期生存的不利危险因素为高龄、高血压和低左心室射血分数（LVEF）。
接受CABG再次手术患者的累积生存和无心脏事件生存的长期结果良好。虽然这种再次手术总体上是安全的，但高龄、高血压和LVEF降低会显著增加手术风险。
