Vallejo J L, González-Santos J M, Guisasola J S, Albertos J, Castaño M, Ruiz M, Riesgo M J, Bastida E, Rico M J, Fortuny R, González de Diego F, Alvarez Valdivielso M
Servicio de Cirugía Cardiovascular, Hospital General Universitario Gregorio Marañón, Madrid.
Rev Esp Cardiol. 1998;51 Suppl 3:86-92.
Coronary by-pass grafting is a well established procedure for ameliorating ischemic coronary disease. From time to time it is necessary to re-operate these patients. The objective of our paper is to present our experience in this field. Retrospective analysis of 128 patients operated on between February 1978 and November 1996, has been analyzed. The mean age was 57.4 +/- 0.7 years. 77.2 +/- 5 months elapsed between operations. Stable angina (20.4%) or unstable angina (76.3%), myocardial infarction (48%) and congestive heart failure (17%) were the predominant clinical manifestations.
Hospital mortality was 10.9% (14 patients) and in the follow-up there were 16 deaths (14%). Perioperative myocardial infarction was the main cause of in-hospital mortality. In the follow-up there were 4 deaths due to myocardial infarction and another 4 patients died from neoplasms. Perioperative myocardial infarction was present in 9.3% (12 patients)
a) Re-do coronary by-pass grafting is still a good procedure for solving myocardial ischemia in spite of a higher mortality and morbidity than in the original operation. b) There is no progression in the number of patients according to our experience, probably due to better techniques and the frequent actions by an intervention cardiologist. c) The long-term results are good enough, but with a higher mortality.
冠状动脉搭桥术是改善缺血性冠状动脉疾病的一种成熟手术。这些患者有时需要再次手术。我们本文的目的是介绍我们在该领域的经验。对1978年2月至1996年11月期间接受手术的128例患者进行了回顾性分析。平均年龄为57.4±0.7岁。两次手术间隔时间为77.2±5个月。主要临床表现为稳定型心绞痛（20.4%）或不稳定型心绞痛（76.3%）、心肌梗死（48%）和充血性心力衰竭（17%）。
医院死亡率为10.9%（14例患者），随访中有16例死亡（14%）。围手术期心肌梗死是院内死亡的主要原因。随访中有4例死于心肌梗死，另有4例死于肿瘤。围手术期心肌梗死发生率为9.3%（12例患者）。
a）尽管再次冠状动脉搭桥术的死亡率和发病率高于初次手术，但仍是解决心肌缺血的良好手术。b） 根据我们的经验，患者数量没有增加，这可能是由于技术改进以及介入心脏病专家的频繁干预。c） 长期结果足够好，但死亡率较高。
