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Ann Thorac Surg 2000;69:474
© 2000 The Society of Thoracic Surgeons

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Invited Commentaries

^a Division of Cardiothoracic Surgery, University of Hong Kong, Grantham Hospital, 125 Wong Chuk Hang Rd, Aberdeen, Hong Kong

e-mail: gwhe{at}hkucc.hku.hk

Invited commentary

With the increasing number of the patients who have undergone coronary artery bypass grafting (CABG), the incidence of reoperative CABG is also increasing. In an early report, the reoperative incidence for CABG is approximately 3% at 5 years, 11% at 10 years, and 17% at 12 years [1]. The Society of Thoracic Surgeons (STS) national database experience also indicates that the incidence of reoperation for CABG has a progressive increase, from 1.9% in 1980 to 7.0% in 1990 [2]. Therefore, a large patient population after the primary CABG will be at high risk of reoperation. It is well documented that reoperative CABG carries a higher mortality than primary CABG, ranging from 3.4% to 12.5% [3]. We have previously analyzed risk factors for reoperative CABG and found that preoperative cardiac function, old age, female gender, history of arrhythmia, emergency operation, and long perfusion time are risk factors for reoperative CABG [3]. The present study from the Cleveland Clinic provides information that not only for operative mortality but also for 10-year survival in the high-risk reoperative CABG group - age more than 70 years. The reoperation for those patients, as the study demonstrated, is still a significant surgical challenge. On the one hand, in these patients the reoperation can be performed with acceptable hospital mortality (7.6%) and the postoperative symptomatic relief is excellent. Further, the survival (75% at 5 years and 49% at 10 years) is also acceptable for these elderly patients. On the other hand, the risk-benefit ratio of surgery should be considered carefully in this group of high-risk patients. As correctly indicated by the authors, the decision of reoperative CABG in the elderly should be on the individual basis with a careful risk-benefit estimation.

References

1. Cosgrove D.M., Loop F.D., Lytle B.W., Gill C.C., Golding L.A.R., Gibson C., Stewart R.W., Taylor P.C., Goormastic M. Predictors of reoperation after myocardial revascularization. J Thorac Cardiovasc Surg 1986;92:811-821.[Abstract]
2. Edwards F.H., Clark R.E., Schwartz M. Coronary artery bypass grafting. Ann Thorac Surg 1994;57:12-19.[Abstract]
3. He G.-W., Acuff T.E., He Y.-H., Ryan W.H., Mack M.J. Determinants of operative mortality in reoperative coronary bypass grafting. J Thorac Cardiovasc Surg 1995;110:971-978.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Guo-Wei He Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by He, G.-W. Search for Related Content PubMed Articles by He, G.-W. Related Collections Related Article