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Ann Thorac Surg 1996;62:1801-1807
© 1996 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Third-Time Coronary Artery Bypass Operations: Surgical Strategy and Results

Division of Cardiothoracic Surgery, Joseph P. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia

Accepted for publication June 28, 1996.

Background. Increasingly, patients are returning for a second, third, and even fourth coronary artery bypass graft (CABG) procedure.

Methods. This report reviews the in-hospital and long-term outcomes for 102 patients undergoing a third or fourth CABG at Emory University from December 1977 to April 1994.

Results. The mean interval from the first to second CABG was 5.2 ± 3.5 years and from the second to the third CABG 6.8 ± 4.1 years. The mean age was 60 ± 9 years, 91% were male, 33% had hypertension, 16% diabetes, 86% class III or IV angina (Canadian Cardiovascular Society), 4.4% congestive failure (New York Heart Association), and 73% three-vessel disease. The in-hospital mortality rate was 9.8%, with a perioperative myocardial infarction rate of 8.8% and a stroke rate of 1.9%.

Conclusions. These perioperative mortality and myocardial infarction rates are several times higher than those reported for initial revascularizations or first-time redo CABG operations. However, the 5- and 10-year survival rates of 79% and 59%, respectively, and a myocardial infarction-free survival of 62% at 5 years, the benefits of a third-time CABG procedure are apparent for this high-risk group of patients.

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