Vouhé P R, Danchin N, Du Cailar C, Hélias J, Grondin C M
Arch Mal Coeur Vaiss. 1980 Feb;73(2):124-30.
40 patients presented with invalidating angina after initial revascularisation surgery (44 operations). The relapse of angina was attributed to thrombosis or stenosis of the graft (33 p. 100), graft failure plus the presence of non-bypassed coronary lesions (progression of coronary artery disease or incomplete initial revascularisation) (52 p. 100) or to the presence alone of coronary lesions which had not been bypassed (15 p. 100). At reoperation 37 stenosed or thrombosed grafts were replaced or repaired and 36 new aortocoronary bypasses were implanted. The perioperative risk was comparable to that of the initial operation (4,5 p. 100 mortality, 13,6 p. 100 myocardial infarction). The long term clinical improvement (34 months) was however less satisfactory (30 p. 100 unimproved). Several factors may account for the relatively high failure rate: the incidence of incomplete revascularisation; perioperative myocardial infarction and, above all, rapid progression of the coronary artery disease. Reoperation for myocardial revascularisation should therefore be restricted to patients with severe angina despite medical therapy, in whom the angiographic appearances suggest that optimal revascularisation might be possible.
40例患者在初次血运重建手术后出现顽固性心绞痛（共进行了44次手术）。心绞痛复发归因于移植物血栓形成或狭窄（占100例中的33例）、移植物功能衰竭加上存在未搭桥的冠状动脉病变（冠状动脉疾病进展或初次血运重建不完全）（占100例中的52例）或仅归因于存在未搭桥的冠状动脉病变（占100例中的15例）。再次手术时，37个狭窄或血栓形成的移植物被替换或修复，并植入了36条新的主动脉冠状动脉旁路移植血管。围手术期风险与初次手术相当（死亡率4.5%，心肌梗死发生率13.6%）。然而，长期临床改善情况（34个月）不太令人满意（30%未改善）。几个因素可能导致相对较高的失败率：血运重建不完全的发生率；围手术期心肌梗死，最重要的是冠状动脉疾病的快速进展。因此，心肌血运重建再次手术应仅限于尽管接受了药物治疗仍有严重心绞痛、血管造影表现提示可能实现最佳血运重建的患者。
