Verkkala K, Järvinen A, Virtanen K, Keto P, Pellinen T, Salminen U S, Ketonen P, Luosto R
Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
Scand J Thorac Cardiovasc Surg. 1990;24(1):1-6. doi: 10.3109/14017439009101813.
Seventy-one coronary artery bypass grafting (CABG) reoperations were performed during a 17-year period, comprising 2.7% of all CABG operations. The main indication (in 87%) was vein graft failure alone or combined with other causes. Progression of disease in native coronary arteries was the sole indication in only 4 of the 71 cases. There were seven perioperative deaths, mainly due to myocardial infarction. Significant perioperative complications arose in 36 cases, including intraoperative lesion of a previous left internal mammary graft (16.2%) or of the right ventricle or anterior descending branch of the left coronary artery (2.8%). Postoperative low output syndrome appeared in 13 patients (18.3%), in seven of whom myocardial infarction was verified. Postoperative bleeding required resternotomy in six cases (9.1%). Because of the heightened operative mortality and morbidity risks, indications for redo CABG should be individualized. A well functioning internal mammary artery graft may be a relative contraindication. Accurate knowledge of the previous operation is essential and, especially in young patients, the possibility of reoperation should be taken into consideration at initial CABG.
在17年期间共进行了71例冠状动脉旁路移植术（CABG）再次手术，占所有CABG手术的2.7%。主要指征（87%）是单纯静脉移植血管失败或合并其他原因。在71例中仅有4例的唯一指征是自身冠状动脉疾病进展。围手术期死亡7例，主要原因是心肌梗死。36例出现显著的围手术期并发症，包括术中损伤既往的左乳内动脉移植血管（16.2%）或右心室或左冠状动脉前降支（2.8%）。13例患者（18.3%）出现术后低心排综合征，其中7例证实有心肌梗死。6例（9.1%）术后出血需要再次开胸。由于再次CABG手术的死亡和发病风险增加，再次CABG的指征应个体化。功能良好的乳内动脉移植血管可能是相对禁忌证。准确了解既往手术情况至关重要，尤其是对于年轻患者，初次CABG时应考虑再次手术的可能性。
