Grinda J M, Zegdi R, Couetil J P, Chauvaud S, Deloche A, Fabiani J N, Carpentier A
Cardiac Surgery Department, Broussais Hospital, Paris University, France.
J Cardiovasc Surg (Torino). 2000 Oct;41(5):703-8.
We review twelve-year experience with coronary reoperations so as to better identify indications, techniques and results.
Between January 1986 and March 1998, 240 coronary reoperations (228 redux, 12 tridux) were performed. There were 223 male and 17 female patients, with a mean age of 63.6+/-7.9 years at the time of reoperation. Mean time interval between operations was 10+/-4.8 years. Symptomatology consisted of: stable recurrent angina (40%), unstable (57%), or congestive heart failure (3%). Pathological feature of the primary grafts was implicated in 95% of cases and atheroma sole progression over native network in 5% of cases. During reoperations 521 (2.2+/-0.8/patient) bypass [venous (40%), arterial (60%)] were performed as well as 15 associated procedures.
Operative mortality represented 10% (n=24). Causes of death included infarct (7), left ventricular failure (12), rhythm disorders (2), mediastinitis (1) and multiorgan failure (2). Mortality risk factors were operation date (16.6% before 1992 and 7.4% after, p=0.03), age (13.1% after 60 years old, 2.7% before, p=0.01) time interval between intervention (12% after 8 years, 4% before, p=0.05) and anterograde cardioplegia only (11.8% versus 4.5% when a combined anterograde and retrograde access was used, p=0.06). Morbidity was 31% (71/240). Among the survivors 169 patients (78%) did not experience any complication.
Thanks to a better medico-surgical management, the mortality rate of coronary reoperations is steadily decreasing.
我们回顾了12年的冠状动脉再次手术经验，以便更好地确定手术指征、技术和结果。
1986年1月至1998年3月期间，共进行了240例冠状动脉再次手术（228例二次手术，12例三次手术）。患者中男性223例，女性17例，再次手术时的平均年龄为63.6±7.9岁。两次手术之间的平均时间间隔为10±4.8年。症状包括：稳定型复发性心绞痛（40%）、不稳定型（57%）或充血性心力衰竭（3%）。95%的病例中主要移植物存在病理特征，5%的病例中仅为粥样硬化在原有血管网络上的进展。再次手术期间，共进行了521次旁路移植术（每位患者2.2±0.8次）[静脉（40%），动脉（60%）]，以及15项相关手术。
手术死亡率为10%（n=24）。死亡原因包括梗死（7例）、左心室衰竭（12例）、心律失常（2例）、纵隔炎（1例）和多器官衰竭（2例）。死亡风险因素包括手术日期（1992年前为16.6%，之后为7.4%，p=0.03）、年龄（60岁后为13.1%，之前为2.7%，p=0.01）、两次干预之间的时间间隔（8年后为12%，之前为4%，p=0.05）以及仅采用顺行心脏停搏（采用顺行和逆行联合灌注时为11.8%，仅采用顺行灌注时为4.5%，p=0.06）。并发症发生率为31%（71/240）。在幸存者中，169例患者（78%）未出现任何并发症。
由于更好的药物和手术管理，冠状动脉再次手术的死亡率正在稳步下降。
