[Coronary reoperation: indications, methods and immediate postoperative prognosis. Retrospective study of 184 reoperations].

The authors performed 184 coronary reoperations (172 redux, 12 tridux) between January 1986 and december 1995 in 177 patients (165 men, 12 women) with an average age at surgery of 62.9 +/- 7.6 years. The average interval between the surgical procedures was 9.5 +/- 4.5 years. The symptoms were recurrent angina, stable in 44%, unstable in 51%, and cardiac failure, 7%. Graft dysfunction was the cause in 94.5% of cases with progression of atheroma of the native coronary vessels in only 5.6% of cases. At reoperation 389 bypass procedures were performed (venous 39.5%, arterial 60.5%) (2.1 +/- 0.6 per patient) with 10 associated procedures (3 mitral valvuloplasties, 2 left ventricular aneurysmectomy, 3 aortic valve replacements, 1 replacement of the ascending aorta, 1 carotid endarteriectomy). The operative mortality was 10.9%. The causes of the 20 deaths were myocardial infarction (7), left ventricular failure (8), arrhythmias (2), mediastinitis (1) and multi-organ failure (2). The risk factors for death were: the date of surgery (19% before 1991 and 8% after: p = 0.03), age (18% after 60 years, 2% before: p = 0.015), the interval between the surgical procedures (33% after 15 years, p = 0.02), anterograde cardioplegic injection alone (15% versus 4.5% when mixed antero and retrograde perfusion was used: p = 0.02). The morbidity was 28% (52/184 patients); 132 patients (72%) had uncomplicated postoperative courses. The incidence of repeat coronary artery surgery is in constant progression. Improved medico-surgical management should continue to reduce the mortality which is still high.