Mid-Term Outcomes and Angiographic Patency of Redo Coronary Artery Bypass Grafting: A Comparison between Off-Pump and On-Pump Surgery
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¼Õ¼®È£ ( Sohn Suk-Ho )
Seoul National University College of Medicine Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
±è½ÂÇö ( Kim Seung-Hyun )
Seoul National University College of Medicine Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
Ȳȣ¿µ ( Hwang Ho-Young )
Seoul National University College of Medicine Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
±è±âºÀ ( Kim Ki-Bong )
Seoul National University College of Medicine Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
Abstract
Background: We evaluated the mid-term outcomes and angiographic patency of redo coronary artery bypass grafting (CABG).
Methods: Of 2,851 patients who underwent isolated CABG at Seoul National University Hospital from 2000 to 2017, 88 underwent redo CABG. Patients¡¯ mean age at redo CABG was 66.0¡¾8.0 years. The mean interval between the first-time and redo CABG was 113.0¡¾62.4 months. The mean follow-up duration was 86 months. Early and mid-term clinical outcomes were evaluated. Angiographic patency rates were evaluated early (1?2 days), 1 year, and 5 years after surgery. Comparative analyses between on-pump and off-pump CABG were also performed.
Results: The culprits for reoperation were previous grafts (65.6%), native coronary vessels (17.8%), and both (16.7%). Off-pump CABG was performed in 75 cases (85.2%), and the mean number of distal anastomoses was 1.8¡¾0.8. The saphenous vein (39.7%) was used most frequently, followed by the right internal thoracic artery (28.4%), right gastroepiploic artery (21.3%), left internal thoracic artery (7.8%), and radial artery (2.8%). Operative mortality was 1.1%. The overall survival, cumulative incidence of cardiac death, and cumulative incidence of major adverse cardiac events were 71.3%,12.0%, and 23.3% at 5 years after surgery, respectively. The overall angiographic patency rates were 95.7%, 90.1%, and 92.2% on early, 1-year, and 5-year angiograms, respectively. The angiographic patency rates of saphenous vein grafts were 93.1%, 85.6%, and 91.3% on early, 1-year, and 5-year angiograms, respectively. No significant differences in clinical outcomes or angiographic patency rates were observed between the on-pump (n=13) versus off-pump (n=75) groups. Multivariable analysis revealed that age (hazard ratio [HR], 1.07; p=0.005) and chronic kidney disease (HR, 3.85; p=0.001) were risk factors for all-cause mortality.
Conclusion: Redo CABG could mostly be performed using the off-pump technique and did not show increased operative mortality and morbidities.
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Coronary artery bypass; Reoperation; Coronary angiography
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