Lytle B W, Loop F D, Cosgrove D M, Taylor P C, Goormastic M, Peper W, Gill C C, Golding L A, Stewart R W
J Thorac Cardiovasc Surg. 1987 Jun;93(6):847-59.
Fifteen hundred consecutive patients undergoing a first reoperation for coronary revascularization were reviewed to determine early and late results and predictors of survival. Patients were subdivided into cohorts on the basis of the year of reoperation: Group A (1967 to 1978, 436 patients); Group B (1979 to 1981, 439 patients); and Group C (1982 to 1984, 625 patients). Overall operative mortality was 3.4% (51 deaths): 4.6%, 2.3%, and 3.4% for Groups A, B, and C, respectively. Group C had significantly more women (p = 0.01) and patients with triple-vessel disease, left main coronary artery stenosis (greater than or equal to 50%), abnormal left ventricular function, age greater than or equal to 70 years, and graft failure as a surgical indication (all p less than 0.001). The mean interval between operations increased from 50 months for Group A to 84 months for Group C. At reoperation, Group C patients received more grafts, more internal mammary artery grafts, and had a higher prevalence of complete revascularization (all p less than 0.001). Univariate and multivariate analyses identified left main stenosis (p less than 0.0001), Class III or IV symptoms (p = 0.0002), advanced age (p = 0.0006), Group A (p = 0.02), and incomplete revascularization (p = 0.004) as predictors of increased in-hospital mortality. Follow-up of in-hospital survivors (mean interval 54 months, range 13 to 171 months) documented a 5 year survival rate of 90% and a 10 year survival rate of 75%. Multivariate testing identified advanced age (p less than 0.0001), hypertension (p less than 0.0001), and abnormal left ventricular function (p less than 0.0001) as predictors of decreased late survival.
对1500例接受首次冠状动脉血运重建再次手术的连续患者进行回顾性研究，以确定早期和晚期结果以及生存预测因素。根据再次手术年份将患者分为几组：A组（1967年至1978年，436例患者）；B组（1979年至1981年，439例患者）；C组（1982年至1984年，625例患者）。总体手术死亡率为3.4%（51例死亡）：A组、B组和C组分别为4.6%、2.3%和3.4%。C组女性患者明显更多（p = 0.01），且三支血管病变、左主干冠状动脉狭窄（大于或等于50%）、左心室功能异常、年龄大于或等于70岁以及因移植失败作为手术指征的患者更多（所有p均小于0.001）。手术间隔时间的均值从A组的50个月增加到C组的84个月。再次手术时，C组患者接受的移植血管更多、胸廓内动脉移植血管更多，完全血运重建的患病率更高（所有p均小于0.001）。单因素和多因素分析确定左主干狭窄（p小于0.0001）、Ⅲ或Ⅳ级症状（p = 0.0002）、高龄（p = 0.0006）、A组（p = 0.02）和不完全血运重建（p = 0.004）是住院死亡率增加的预测因素。对住院幸存者进行随访（平均间隔54个月，范围13至171个月），记录显示5年生存率为90%，10年生存率为75%。多因素检验确定高龄（p小于0.0001）、高血压（p小于0.0001）和左心室功能异常（p小于0.0001）是晚期生存率降低的预测因素。
