Evaluations of factors affecting the outcome of redo coronary bypass surgery and long term results: A retrospective observational study

Abstract

Aim: Advanced atherosclerosis of coronary arteries, existence of patent arterial grafts, redo sternotomy, shortage of available vascular conduits, difficulty of exploration of the coronary vessels are the factors that render the coronary reoperations challenging and they may be responsible of higher mortality and morbidity rates of reoperations. The aim of this study is to evaluate the factors that affect the progression of atherosclerotic coronary artery disease in the post-operative period of coronary artery bypass surgery which results in a redo operation. 

Methods: A number of 115 patients who underwent coronary bypass re-operations between January 1997 and August 2007 were included.  Patients were divided into two groups as follows: Group 1 was the risk factor positive group, Group 2 was the risk factor negative group. The time interval between the initial operative procedure and the redo operation was calculated and the effect of risk factors upon this time interval and the mortality rates were evaluated. 

Results: The time interval between the first operative procedure and the reoperation was 77.31 months in Group 1 and 93.88 months in Group 2. Smoking had a more negative effect on the reoperation rate compared to the other risk factors (p=0.025). Mortality rate was higher in the risk factor positive group (p=0.027). Preoperative EF had a significant effect on the mortality rates (p=0.018).  

Conclusion: The presence of any risk factor for CAD increases the chance of having a reoperation. Off-pump surgery technique should be chosen in appropriate cases to lower the mortality risk of redo CABG operations and choosing the combined cardioplegia administration in on-pump redo coronary bypass operations would lower the mortality rate as well.

Keywords

• Coronary artery bypass surgery,Vascular graft occlusion,Redo surgery

Redo koroner arter bypass ameliyatlarının sonuçlara etki eden faktörler ve uzun dönem sonuçların değerlendirilmesi: Retrospektif gözlemsel çalışma

Öz

Amaç: Koroner arterlerin ilerlemiş aterosiklerozu, patent arteryal greftlerin varlığı, redo sternotomi, muhtemel vasküler kondüitlerin kısalığı, koroner damarların eksplorasyonundaki zorluklar gibi faktörler koroner reoperasyonları zorlu hale getiren etkenler olup reoperasyonlarda gözlenen daha yüksek mortalite ve morbidite oranlarından sorumludurlar. Bu çalışmanın amacı redo koroner arter baypas greftleme (KABG) ameliyatlarında postoperatif dönemde aterosklerotik koroner arter hastalığının progresyonuna etki eden faktörleri değerlendirmektir.

Yöntemler: Ocak 1997 ve Ağustos 2007 tarihleri arasında redo KABG ameliyatı yapılan 115 hasta çalışmaya dahil edildi. Hastalar şu şekilde iki gruba ayrıldı: Grup 1 risk faktörü pozitif olan grup, Grup 2 risk faktörü negatif olan grup. İlk ameliyat ile redo ameliyat arasındaki süre ve bu süre üzerine etki eden risk faktörleri ile mortalite oranları değerlendirildi.

Bulgular: İlk ameliyat ile tekrarlanan ameliyat arasında geçen süre Grup 1’de ortalama 77,31 ay iken Grup 2’de 93,88 ay idi. Diğer risk faktörleri ile karşılaştırıldığında sigara kullanımı tekrarlayan ameliyat üzerinde daha güçlü bir negatif etkiye sahipti (p=0,025). Risk pozitif olan grupta mortalite oranı daha yüksekti (p=0,027). Preoperatif ejeksiyon fraksiyonu mortalite oranları üzerinde önemli bir etkiye sahipti (p=0,018).

Sonuç: Koroner arter hastalığı ile ilgili herhangi bir risk faktörü varlığı redo KABG olasılığını artırmaktadır. Klinik tecrübelerimize dayanarak, redo KABG’nin mortalite oranlarını azaltmak için uygun olan vakalarda off-pump cerrahi tekniği tercih edilmelidir. Aynı zamanda on-pump redo KABG olgularında kombine kardiyopleji uygulaması mortalitenin azaltılmasına yardımcı olacaktır.

Anahtar Kelimeler

• Koroner arter baypas greftleme,Vasküler greft tıkanması,Redo ameliyat

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