Osaka S, Barratt-Boyes B G, Brandt P W, Kerr A R, Whitlock R M
Department of Cardiac Surgery, Green Lane Hospital, Auckland, New Zealand.
Aust N Z J Surg. 1988 Jul;58(7):537-41. doi: 10.1111/j.1445-2197.1988.tb06190.x.
A second coronary artery bypass grafting procedure was performed for recurrent angina in 119 patients between 1970 and mid-1983. Angiographic findings were assessed and computerized using the Brandt myocardial scoring system. The myocardial score was similar prior to the first and second operations. Graft failure was the most common indication for re-operation, either alone (48%) or in combination with progression of coronary artery disease (29%) or incomplete revascularization (10%). Progression of coronary artery disease alone was an indication in 9% and previous incomplete revascularization alone in 4%. The completeness of revascularization at the end of operation was analysed using a new index, the myocardial score/graft coverage rate. This showed that revascularization was less complete at the second operation than at the first (P less than 0.0001). The hospital mortality at re-operation was 2.5% and the peri-operative myocardial infarction rate was 9.2%. The follow-up period was 54 months (range 10-160 months). Actuarial survival was 94% at 5 years and 74% at 10 years. The average onset of recurrent angina was earlier after the second operation than after the first (P = 0.001). Using a cumulative actuarial curve, survival at 8 years was 85%, a further 6% of patients had undergone a third or fourth operation, and a further 25% were in NYHA Classes III or IV. Therefore 54% achieved a good or excellent result. It was concluded that re-operation is a worthwhile procedure.
1970年至1983年年中，对119例复发性心绞痛患者进行了第二次冠状动脉搭桥手术。使用布兰特心肌评分系统对血管造影结果进行评估并进行计算机分析。首次和第二次手术前的心肌评分相似。移植失败是再次手术最常见的指征，单独出现的情况占48%，与冠状动脉疾病进展（29%）或血管重建不完全（10%）合并出现的情况占29%。单独的冠状动脉疾病进展是再次手术指征的情况占9%，之前单独的血管重建不完全是再次手术指征的情况占4%。使用一个新的指标——心肌评分/移植覆盖率，分析了手术结束时血管重建的完整性。结果显示，第二次手术时的血管重建不如第一次完全（P<0.0001）。再次手术时的医院死亡率为2.5%，围手术期心肌梗死率为9.2%。随访期为54个月（范围10 - 160个月）。5年时的精算生存率为94%，10年时为74%。复发性心绞痛的平均发作时间在第二次手术后比第一次手术后更早（P = 0.001）。使用累积精算曲线，8年时的生存率为85%，另有6%的患者接受了第三次或第四次手术，还有25%的患者处于纽约心脏协会III级或IV级。因此，54%的患者取得了良好或优异的结果。得出的结论是，再次手术是一项值得进行的手术。
