Ann Thorac Surg 1993;55:582-584
© 1993 The Society of Thoracic Surgeons
Articles
Third-time coronary artery bypass grafting: Midterm results
Walter H. Merrill, MD*,
C.Craig Elkins, MD,
James R. Stewart, MD,
William H. Frist, MD,
Harvey W. Bender, Jr, MD
Department of Cardiac and Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
* Address reprint requests to Dr Merrill, The Vanderbiit Clinic, Room 2986, Nashville, TN 37232-5734.
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Abstract
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Minimal data are available regarding the results of patients who have undergone myocardial revascularization more than twice. The records of 13 consecutive patients who underwent a coronary artery bypass procedure for the third time were reviewed. The indication for operation was unstable angina in all patients. All patients were placed on cardiopulmonary bypass through a median stemotomy. The mean number of bypass grafts placed at the third operation was 1.9 (range, 1 to 3 grafts). A new internal mammary artery graft was placed in 6 patients (2 had prior internal mammary artery grafts). Hospital mortality was 7.7% ([equation]). The single death was due to incomplete revascularization in a patient with poor distal vessels. Three patients required intraaortic balloon pump support postoperatively, and 2 patients had prolonged ventilatory insufficiency. There have been no late deaths. The 12 survivors have been followed up a mean of 44 months (range, 6 to 90 months). Four remain asymptomatic; 5 have mild angina easily controlled with medication. All except 1 are in improved condition compared with their preoperative status. We conclude that a third myocardial revascularization can be performed with low mortality and morbidity and with the expectation of long-lasting symptomatic improvement.
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Footnotes
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Presented at the Thirty-ninth Annual Meeting of the Southern Thoracic Surgical Association, Wesley Chapel, FL, Nov 5–7, 1992.
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