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

Yıl 2018, , 130 - 133, 01.05.2018

Levent Altınay , Ertan Demirdaş , Ufuk Mungan Kıvanç Atılgan , Erdem Çetin , Ferit Çiçekçioğlu

https://doi.org/10.28982/josam.401707

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Grinda JM, Zegdi R, Couetil JP, Chauvaud S, Deloche A, Fabiani JN, et al. Coronary reoperations: Indications, techniques and operative results. Retrospective study of 240 coronary reoperations. J Card Surg. 2000;41:703.
• 2. He GW, Acuff TE, Ryan WH, Mack MJ. Determinants of operative mortality in reoperative coronary artery bypass grafting. J Thorac Cardivasc Surg. 1995;110:971.
• 3. Akins CW, Buckley MJ, Daggett WM, Hilgenberg AD, Vlahakes GJ, Torchiana DF, et al. Reoperative coronary grafting: Changing patient profiles, operative indications, techniques and results. Ann Thorac Surg. 1994;58:359.
• 4. Cosgrove DM, Loop FD, Lytle BW, Gill CC, Golding LA, Gibson C, et al. Predictors of reoperation after myocardial revascularization. J Thorac Cardivasc Surg. 1986;92:811.
• 5. Goldman S, Zadina K, Moritz T, Ovitt T, Sethi G, Copeland JG, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery. Results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol. 2004;44(11):2149–56.
• 6. Weintraub WS, Jones EL, Craver JM, Guyton RA. Frequency of repeat coronary bypass or coronary angioplasty after coronary artery bypass surgery using saphenous venous grafts. Am J Cardiol. 1994;73(2):103–12.
• 7. Varghese I, Samuel J, Banerjee S, Breaks ES. Comparison of percutaneous coronary intervention in native coronary arteries vs bypass grafts in patients with prior coronary artery bypass graft surgery. Cardiovasc Revasc Med. 2009 Apr-Jun;10(2):103-9.
• 8. Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: Angiographic follow-up of 5065 grafts related to survival and reoperation in 1388 patients during 25 years. J Am Coll Cardiol. 1996;28:616-26.
• 9. FitzGibbon GM, Keon WJ, Burton JR. Aorta-coronary bypass in patients with coronary artery disease who do not have angina. J Thorac Cardiovasc Surg. 1984 May;87(5):717-24.
• 10. FitzGibbon GM, Kafka HP, Keon WJ. Aorta-coronary bypass in patients with coronary artery disease who do not have angina: a brief follow-up 15 years after the last case reported [letter]. J Thorac Cardiovasc Surg. 1995;110:1155-7.
• 11. Grondin CM. Graft disease in patients with coronary bypass grafts. Why does it start? Where do we stop? J Thorac Cardiovasc Surg. 1986;92:323-9.
• 12. Lytlc BW, Loop FD, Cosgrove D, Ratlif NB. Easlay K, Taylor PC. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg. 1985;89:248-58.
• 13. Somoss BC, Nadeau P, Millette D, Ing B, Campeau L. Late thrombosis of saphenous vein coronary bypass grafts related to risk factors. Circulation. 1988;78 Suppl I&140-3.
• 14. Neitzel GF, Barboriak KP, Qureshi I. Atherosclerosis in aortocoronary bypass grafts: morphologic study and risk factor analysis 6 to 12 years after surgery. Arteriosclerosis. 1986;6:594-60.
• 15. Sabik JF, Blackstone EH, Gillinov AM, Banbury MK, Smedira NG, Lytle BW. Influence of patient characteristics and arterial grafts on freedom from coronary reoperation. J Thorac Cardiovasc Surg. 2006;131:90-8.
• 16. Goldman S, Zadina K, Moritz T, Ovitt T, Sethi G, Copeland JG, et al. Long-Term Patency of Saphenous Vein and Left Internal Mammary Artery Grafts After Coronary Artery Bypass Surgery Results From a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol. 2004 Dec 7;44(11):2149-56.
• 17. Brown G, Albers JJ, Fisher LD, Schaefer SM, Lin JT, Kaplan C, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med. 1990;323:1289–98.
• 18. Blankenhorn DH, Azen SP, Kramsch DM, Mack WJ, Cashin-Hemphill L, Hodis HN, et al. Coronary angiographic changes with lovastatin therapy. The Monitored Atherosclerosis Regression Study (MARS). Ann Intern Med. 1993;119:969–76.
• 19. Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with corona& heart disease: the Scandinavian Simvastatin Sutvival Study (4s). Lancet. 1994;344z1383-9.
• 20. Weintraub WS, Jones EL, Craver JM, Grosswald R, Guyton RA. In-hospital and long-term outcome after reoperative coronary artery bypass sugery. Circulation. 1995; 92:II-50.
• 21. Loop FD, Lytle BW, Cosgrove DM, Woods EL, Stewart RW, Golding LA, et al. Reoperation for coronary atherosclerosis: Changing practice in 2509 consecutive patients. Ann Surg. 1990; 212:378.
• 22. Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah AS, Engoren M, et al. Late outcomes after radial artery versus saphenous vein grafting during reoperative coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2010 Jun;139(6):1511-8.
• 23. Dougenis D, Brown AH. Long-term results of reoperations for recurrent angina with internal mammary artery versus saphenous vein grafts. Heart. 1998;80:9.
• 24. Lytle BW, Cosgrove DM, Taylor PC, et al. Multiple coronary reoperations: Early and late results. Circulation. 1989:80:626.
• 25. Yau TM, Borger MA, Weisel RD, Ivanov J. The changing pattern of reoperative coronary surgery: Trends in 1230 consecutive reoperations. J Thorac Cardiovasc Surg. 2000;120:156.
• 26. Sabik JF, Blackstone EH, Houghtaling PL, Walts PA, Lytle BW. Is Reoperation Still a Risk Factor in Coronary Artery Bypass Surgery? Ann Thorac Surg. 2005;80:1719–27.
• 27. Usta E, Elkrinawi R, Ursulescu A, Nagib R, Mädge M, Salehi-Gilani S, et al. Clinical outcome and quality of life after reoperative CABG: off-pump versus on-pump - observational pilot study. J Cardiothorac Surg. 2013 Apr 5;8:66.
• 28. Al-Jughiman M, Algarni K, Yau T. Outcomes of isolated reoperative coronary artery bypass grafting in elderly patients. J Card Surg. 2015 Jan;30(1):41-6.
• 29. Ngaage DL, Cowen ME, Griffin S, Guvendik L, Cale AR. The impact of symptom severity on cardiac reoperative risk: early referral and reoperation is warranted. Eur J Cardiothorac Surg. 2007 Oct;32(4):623-8.