Coronary artery bypass grafting for the third time or more. Results of 150 consecutive cases.

Through December 1986, coronary artery bypass surgery was performed on 150 patients who had undergone at least two previous myocardial revascularization surgeries. One hundred thirty-seven patients had two, 12 patients had three, and one patient had four previous operations. There were 117 men (78.0%); the mean age was 55.5 years (range, 28-76 years); 137 patients (91.3%) had triple-vessel disease, and 36 (24.0%) had a left ventricular ejection fraction less than 0.40. One hundred forty-nine patients (99.3%) had angina preoperatively, with 142 (94.7%) having Class III and IV angina. Direct myocardial revascularization was performed in all patients, with a mean of 3.3 grafts per patient (range, 1-6). In addition, coronary artery endarterectomy was performed in 70 cases (46.7%): right coronary artery endarterectomy in 15 (10.0%), left coronary artery endarterectomy in 39 (26.0%), and multiple coronary artery endarterectomies in 16 (10.7%). There were 18 in-hospital deaths (12.0%). Statistically significant risk factors for increased early mortality (p less than 0.01) included age over 65 years and left ventricular ejection fraction less than 0.40. Diffuse coronary artery disease requiring multiple coronary artery endarterectomies almost achieved statistical significance as a risk factor (p = 0.06). Complications in the surviving 132 patients included seven nonfatal perioperative myocardial infarctions (5.3%). Follow-up data for a period of 8-172 months (mean, 43.1 months) is available for 100 of 103 patients (97.1%). Five-year actuarial survival was 76.4% for the entire series and 87.3% for hospital survivors.(ABSTRACT TRUNCATED AT 250 WORDS)