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Original Articles: Adult Cardiac

Changing Pattern of Reoperative Coronary Artery Bypass Grafting: A 20-Year Study

Peter Munk Cardiac Centre, Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada

Accepted for publication March 21, 2011.

^_* Address correspondence to Dr Rao, Toronto General Hospital, 200 Elizabeth St, 4N-464, Toronto, ON M5G 2C4, Canada (Email: vivek.rao{at}uhn.on.ca).

Presented at the Fifty-seventh Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 3–6, 2010.

Background: Fewer patients are undergoing reoperative coronary artery bypass grafting (CABG). We investigated the prevalence of redo vs primary CABG and previous percutaneous coronary intervention (PCI), changing trends in preoperative risk profiles, and independent predictors of operative death.

Methods: Data on demographic characteristics, preoperative risk factors, and hospital outcomes were collected prospectively for patients undergoing isolated reoperative CABG from January 1, 1990, to December 31, 2009. To examine the effect of time on the prevalence of redo CABG cases and previous PCI, we divided patients into four groups: 1990 through 1994, 470; 1995 through 1999, 415; 2000 through 2004, 240; and 2005 through 2009, 79. To examine risk profiles and outcomes, we created two groups: 1990 through 1999, 885; 2000 through 2009, 319.

Results: Redo CABG decreased from 7.2% (1990 through 1994) to 2.2% (2005 through 2009). PCI before redo CABG significantly increased from 14.5% (1990 through 1994) to 26.6% (2005 through 2009). Patients with diabetes, dyslipidemia, hypertension, peripheral vascular disease, and left main disease increased. In-hospital mortality did not change significantly, but postoperative low cardiac output syndrome dropped. Age (odds ratio [OR], 1.04), peripheral vascular disease (OR, 2), congestive heart failure (OR, 5.8), and preoperative shock (OR. 9.7) independently predicted higher operative mortality.

Conclusions: Reoperative CABG has significantly decreased. The increased prevalence of PCI before redo CABG is one of the reasons. Despite an increasing risk profile, hospital outcomes have remained largely the same. Preoperative shock and congestive heart failure are the most important predictors of operative mortality.

This article has been cited by other articles:

				R. K. Ghanta, T. Kaneko, J. S. Gammie, S. Sheng, and S. F. Aranki Evolving trends of reoperative coronary artery bypass grafting: An analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database J. Thorac. Cardiovasc. Surg., February 1, 2013; 145(2): 364 - 372. [Abstract] [Full Text] [PDF]