Repeated coronary artery bypass grafting in patients with patent atherosclerotic grafts: a special challenge.

The operative risk and results of reoperations in patients with long-standing atherosclerotic vein grafts are not well-known. We have had 38 such patients among our last 102 cases of repeated revascularization procedure (37.2%). Six out of those 38 patients were operated taking special measures to avoid atheromatous material displacement and they were compared to the remaining 32 operated on in a conventional way. In addition, all patients, as a group, were compared to another 64 patients undergoing the same procedure in the same time interval but presenting either healthy or occluded grafts. Perioperative myocardial infarction was specially studied. It was more frequent in those with atherosclerotic grafts (23.7 % versus 9.4%) and, among them, in those operated on in a conventional way (25% versus 16.7%). Operative mortality was also higher in the same groups: 13.2% versus 3.1% for atherosclerotic versus non atherosclerotic graft carriers and 15.6% versus none of those operated on in a conventional way versus those in whom special measures were taken. The late results so far are also suboptimal in the same risk groups, although a mean follow-up of 6 months is too brief a period of time. We can therefore conclude that patients with patent atherosclerotic vein grafts have a higher operative risk and worse long-term results, mainly related to a greater perioperative myocardial infarction rate. Special measures to avoid the latter event are warranted.