Coronary reoperations: recurrence of XXXX and clinical outcome with and without cardiopulmonary bypass.

@entity1 @entity951 @entity3362
BACKGROUND: We compared our experience of minimal tissue dissection and target vessel revascularization without cardiopulmonary bypass (CPB) with the standard procedure of total dissection of the heart and complete revascularization with CPB in @entity1 who had elective reoperative coronary artery bypass grafting (redo-CABG). METHODS: We analyzed recurrence of @entity951 and clinical outcome in 118 @entity1 who had elective redo-CABG between January 1995 and April 2002. Seventy-four @entity1 had redo-CABG with CPB, and 44 @entity1 had redo-CABG without CPB. RESULTS: Perioperative outcome was comparable with regard to morbidity and mortality rates. At follow-up, the mean Canadian Cardiovascular Society score was 1.3 +/- 0.6 in @entity1 who had redo-CABG with CPB and 1.7 +/- 0.8 in @entity1 who had redo-CABG without CPB (p = 0.02). At follow-up, @entity1 who had redo-CABG without CPB had a higher rate of recurrence of @entity951 (log rank = 0.001) and higher use of @entity3362 (p = 0.015). Target vessel revascularization was an independent predictor of recurrence of @entity951 in younger @entity1 (< 75 years; p = 0.012) but not in the elderly (> or = 75 years; p = 0.142). CONCLUSIONS: In elective redo-CABG @entity1 , minimal tissue dissection and target vessel revascularization without cardiopulmonary bypass did not add significant benefit with regard to perioperative morbidity and mortality. The unsatisfactory relief of symptoms does not seem to justify target vessel revascularization by a less invasive approach. Therefore, this technique should be offered exclusively to @entity1 at high risk with complete revascularization using CPB, such as the elderly.
