Ivert T S, Ekeström S, Péterffy A, Welti R
Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
Scand J Thorac Cardiovasc Surg. 1988;22(2):111-8. doi: 10.3109/14017438809105939.
Coronary artery reoperation was performed on 101 patients between 1972 and 1985. The resternotomy was associated with major hemorrhage in 12 cases. Of 29 patent internal mammary artery (IMA) grafts, 11 (38%) were damaged during mobilization of the left ventricle. At reoperations performed more than a year after the initial operation, increased graft blood flow compared with the first operation was observed in IMA but not in vein grafts. There were six early deaths (6%). The 5-year survival rate, inclusive of early mortality, was 90%. After a median of 2.5 years, 82% of the patients reported symptomatic improvement and 22% were completely free from angina, but full physical fitness was restored in only 3%. Excluding the patients of retirement age, 35% were able to resume work after the reoperation. Coronary artery reoperation should be considered only for patients with severe angina, because of the increased surgical risk and the lower likelihood of completely relieved symptoms. Presence of a patent IMA graft necessitates special caution.
