Christenson J T, Schmuziger M, Simonet F
The Cardiovascular Surgery Unit, Hôpital de la Tour, Meyrin-Geneva, Switzerland.
Eur J Cardiothorac Surg. 1997 Jan;11(1):129-33. doi: 10.1016/s1010-7940(96)01030-5.
The number of coronary artery disease reoperations is increasing. The aim of this paper is to identify risk factors and evaluate the results of REDO coronary artery bypass grafting (CABG).
Between January 1984 and October 1994, 594 patients underwent REDO-CABG and 3157 underwent primary-CABG. The mean age was 62 years with 84% men. Hypertension, hyperlipidemia, insulin dependent diabetes, smoking and renal insufficiency were all more frequent in the REDO-group. A significantly higher number of patients undergoing REDO-CABG were in the Canadian Cardiovascular Society (CCS) angina class 3 and 4, had instable angina, had left main stem stenosis of greater than 70% and 3-vessel disease compared to those undergoing primary-CABG. The mean preoperative left ventricular function (LVEF) was 49.8 (REDO) vs. 58.2%, with a P value of less than 0.001.
The overall postoperative mortality rate for REDO-operations was 9.6 (57/594) vs. 2.8% for primary-CABG. Patients with a reoperative interval of more than 1 year had an 8.9% mortality rate, compared to those reoperated less than 1 year after the initial CABG, where the mortality was 21% with a P value of less than 0.05. Postoperative low cardiac output syndrome, intraaortic balloon pump support, prolonged ventilatory support (> 24 h), hemorrhage and gastrointestinal complications were prominent features of the REDO-group (all P < 0.01). Urgent operation, CCS class 3 and 4, LVEF of less than 40%, generalized arteriosclerotic disease and advanced age (> 80 years) were independent risk factors for postoperative death in both groups. Preoperative renal insufficiency, diabetes and short interval from primary-CABG were added risk factors in the REDO-group. The 5-years survival rate after REDO-CABG was 89%, while the cardiac event-free survival rate was 79% and at 7 years 84 and 62%, respectively.
Reoperative CABG is effective, but has an increased operative mortality and morbidity. The long-term results are encouraging. Unstable angina, poor preoperative left ventricular function, renal insufficiency, insulin dependant diabetes and an interval shorter than 1 year of the initial operation were independent riskfactors for mortality.
冠状动脉疾病再次手术的数量在增加。本文旨在确定危险因素并评估再次冠状动脉搭桥术（CABG）的结果。
1984年1月至1994年10月期间，594例患者接受了再次CABG，3157例患者接受了初次CABG。平均年龄为62岁，男性占84%。再次手术组中高血压、高脂血症、胰岛素依赖型糖尿病、吸烟和肾功能不全更为常见。与初次CABG患者相比，接受再次CABG的患者中，加拿大心血管学会（CCS）心绞痛分级为3级和4级、不稳定型心绞痛、左主干狭窄大于70%以及三支血管病变的患者数量明显更多。术前左心室功能（LVEF）的平均值在再次手术组为49.8%，在初次手术组为58.2%，P值小于0.001。
再次手术的总体术后死亡率为9.6%（57/594），而初次CABG的术后死亡率为2.8%。再次手术间隔超过1年的患者死亡率为8.9%，而初次CABG后不到1年就再次手术的患者死亡率为21%，P值小于0.05。术后低心排血量综合征、主动脉内球囊泵支持、延长通气支持（>24小时）、出血和胃肠道并发症是再次手术组的突出特征（所有P<0.01）。急诊手术、CCS分级3级和4级、LVEF小于40%、全身性动脉硬化疾病和高龄（>80岁）是两组术后死亡的独立危险因素。术前肾功能不全、糖尿病以及初次CABG后间隔时间短是再次手术组额外的危险因素。再次CABG后的5年生存率为89%，无心脏事件生存率为79%，7年时分别为84%和62%。
再次CABG是有效的，但手术死亡率和发病率有所增加。长期结果令人鼓舞。不稳定型心绞痛、术前左心室功能差、肾功能不全、胰岛素依赖型糖尿病以及初次手术间隔时间短是死亡的独立危险因素。
