Background: We review twelve-year experience with coronary reoperations so as to better identify indications, techniques and results.
Methods: Between January 1986 and March 1998, 240 coronary reoperations (228 redux, 12 tridux) were performed. There were 223 male and 17 female patients, with a mean age of 63.6+/-7.9 years at the time of reoperation. Mean time interval between operations was 10+/-4.8 years. Symptomatology consisted of: stable recurrent angina (40%), unstable (57%), or congestive heart failure (3%). Pathological feature of the primary grafts was implicated in 95% of cases and atheroma sole progression over native network in 5% of cases. During reoperations 521 (2.2+/-0.8/patient) bypass [venous (40%), arterial (60%)] were performed as well as 15 associated procedures.
Results: Operative mortality represented 10% (n=24). Causes of death included infarct (7), left ventricular failure (12), rhythm disorders (2), mediastinitis (1) and multiorgan failure (2). Mortality risk factors were operation date (16.6% before 1992 and 7.4% after, p=0.03), age (13.1% after 60 years old, 2.7% before, p=0.01) time interval between intervention (12% after 8 years, 4% before, p=0.05) and anterograde cardioplegia only (11.8% versus 4.5% when a combined anterograde and retrograde access was used, p=0.06). Morbidity was 31% (71/240). Among the survivors 169 patients (78%) did not experience any complication.
Conclusions: Thanks to a better medico-surgical management, the mortality rate of coronary reoperations is steadily decreasing.