Ann Thorac Surg 2009;87:1391. doi:10.1016/j.athoracsur.2009.02.063
© 2009 The Society of Thoracic Surgeons
Original Articles: Adult Cardiac
Invited Commentary
Alfred Tector, MD, MS
Aurora Health Care, 2801 W Kinnickinnic River Pkwy, Ste 530, Milwaukee, WI 53215
(Email: atector{at}wi.rr.com).
Reoperative coronary artery bypass grafting (CABG) continues to be challenging to the cardiothoracic surgeon. Yap and colleagues [1] report 458 patients undergoing reoperative CABG who are part of 13,436 patients enrolled in the Australian Society of Cardio and Thoracic Surgery database from June 2001 through May 2008. The database is voluntarily supported by 70% of the cardiothoracic surgeons in Australia. The patients have the privilege of opting out of the registry [2]. Although postoperative outcomes were encouraging and midterm survival was excellent, reoperation remained a significant risk factor for 30-day mortality.
The authors point out that the strengths of this study include its large number of patients and the multicenter study reflecting "real world practice." Knowledge of the incidence of technical problems associated with reoperation causing injury to structures underlying the sternum, damage to functioning bypass grafts, ischemia causing decreased function of the myocardium, and lack of suitable graft material will be of assistance to the surgeon in selecting the best reintervention therapy for each patient. Careful attention to the increased operative risk of reoperation CABG and the appropriate use of angioplasty and stenting as another method of reintervention should assist in reducing the risk of managing patients in need of reoperation.
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References
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- Yap C-H, Sposato L, Akowuah E, et al. Contemporary results show repeat coronary artery bypass grafting remains a risk factor for operative mortality Ann Thorac Surg 2009;87:1386-1391.[Abstract/Free Full Text]
- Reid CM, Rockell M, Skillington PD, et al. Initial twelve months experience and analysis for 2001–2002 from the Australasian Society of Cardiac and Thoracic Surgeons-Victorian database project Heart Lung Circ 2004;13:291-297.[Medline]
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Contemporary Results Show Repeat Coronary Artery Bypass Grafting Remains a Risk Factor for Operative Mortality
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