Wukasch D C, Toscano M, Cooley D A, Reul G J, Sandiford F M, Kyger E R, Hallman G L
Circulation. 1977 Sep;56(3 Suppl):II3-7.
Among the 5507 patients who underwent aortocoronary bypass between October 1969 and June 1975, 41 patients (0.007%) developed recurrent angina and required reoperation. The factors necessitating reoperation were graft thrombosis in 10 patients (24%), progression of disease in 12 (29%), graft thrombosis and critical unbypassed lesions in one (2.4%), graft failure and progression of disease in in 12 (29%), graft failure and critical unbypassed lesions in four (10%), and all three factors in two patients (4.8%). Among 10 patients with 50% lesions present but not bypassed at the initial operation, nine of these lesions progressed to significant stenosis and in five patients this was the sole reason for reoperation. At the second operation, total revascularization was achieved in 32 patients (78%). One patient (2%) experienced a perioperative myocardial infarction and one patient (2%) died. This study emphasizes the importance of "complete" revascularization at initial operation, the concept that arteries with 50% obstruction should be routinely bypassed, and the conclusion that risks of reoperation are comparable with those of initial aortocoronary bypass, but that long-term relief of angina is less favorable.
在1969年10月至1975年6月期间接受主动脉冠状动脉搭桥手术的5507例患者中，41例（0.007%）出现复发性心绞痛并需要再次手术。需要再次手术的因素包括：10例（24%）移植血管血栓形成，12例（29%）疾病进展，1例（2.4%）移植血管血栓形成和严重未搭桥病变，12例（29%）移植血管功能衰竭和疾病进展，4例（10%）移植血管功能衰竭和严重未搭桥病变，以及2例（4.8%）所有三种因素均存在。在初次手术时存在50%病变但未搭桥的10例患者中，其中9处病变进展为严重狭窄，5例患者这是再次手术的唯一原因。在第二次手术时，32例患者（78%）实现了完全血运重建。1例患者（2%）发生围手术期心肌梗死，1例患者（2%）死亡。本研究强调了初次手术时“完全”血运重建的重要性、50%阻塞动脉应常规搭桥的概念，以及再次手术风险与初次主动脉冠状动脉搭桥手术相当，但心绞痛长期缓解效果较差的结论。
