Redo Coronary Artery Bypass Grafting with and without Cardiopulmonary Bypass in the Elderly
DOI:
https://doi.org/10.1532/hsf.554Abstract
Objectives: Morbidity and mortality rates rise with increasing age in patients undergoing conventional redo coronary artery bypass grafting (CABG). The aim of this study was to compare 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 for a population of elderly patients undergoing elective redo coronary artery CABG.
Methods: We retrospectively analyzed morbidity, mortality, and functional status of 47 patients older than 75 years who underwent redo CABG between January 1995 and June 2002. Thirty-one patients underwent redo CABG with CPB, and 16 patients underwent redo CABG without CPB. Follow-up end points were defined by patient survival, freedom from recurrence of angina (Canadian Cardiovascular Society [CCS] score), freedom from rehospitalizations and reinterventions, and the need for antianginal medication.
Results: There were 2 perioperative deaths (2 in the CPB group versus 0 in the group without CPB; P = .151). Nonfatal myocardial infarction occurred in 3 patients (3 in the CPB group versus 0 in the group without CPB; P = .082). Major adverse cardiac events occurred in 5 patients (5 in the CPB group versus 0 in the group without CPB; P = .058). At the time of follow-up, the mean CCS score of patients who underwent redo CABG with CPB was 1.5 ± 0.8 and was 1.6 ± 0.7 for patients who underwent redo CABG without CPB (P = .432). The rates of angina recurrence (16% with CPB versus 13.3% without CPB; P = .243), use of nitrates (8.7% with CPB versus 14.3% without CPB; P = .542), and survival (89% with CPB versus 93% without CPB; P = .238) were very comparable for the two groups.
Conclusions: In this high-risk subgroup of patients, those patients who underwent target vessel revascularization without CPB showed a trend toward a lower rate of major adverse
References
Akins CW, Dagget WM, Vlahakes GJ, et al. 1997. Cardiac operations in patients 80 years old and older. Ann Thorac Surg 64:606-15.nAllen KB, Matheny RG, Robison RJ, Heimansohn DA, Shaar CJ. 1997. Minimally invasive versus conventional reoperative coronary artery bypass. Ann Thorac Surg 64:616-22.nKilo J, Baumer H, Czerny M, et al. 2001. Target vessel revascularization without cardiopulmonary bypass in elderly high-risk patients. Ann Thorac Surg 71:537-42.nLoop F, Lytle BW, Gill CC, Golding LAR, Cosgrove DM, Taylor PC. 1983. Trends in selection and results of coronary artery reoperations. Ann Thorac Surg 36:380-8.nNashef SAM, Roques F, Michel P, et al. 1999. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 16:9-13.nParsonnet V, Dean D, Bernstein AD. 1989. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 79:I3-12.nPidgeon J, Brooks N, Magee P, Pepper JR, Sturridge MF, Wright JEC. 1985. Reoperation for angina after previous aortocoronary bypass surgery. Br Heart J 53:269-75.nSchaff HV, Orzulak TA, Gersh BJ, et al. 1983. The morbidity and mortality of reoperation for coronary artery disease and analysis of late results with use of actuarial estimate of event-free interval. J Thorac Cardiovasc Surg 85:508-15.nFoster ED, Fisher LD, Kaiser GC, Myers WO. 1984. Comparison of operative mortality and morbidity for initial and repeat coronary artery bypass grafting: the Coronary Artery Surgery Study (CASS) registry experience. Ann Thorac Surg 36:563-70.nGu YJ, Mariani MA, van Oeveren W, Grandjean JG, Boonstra PW. 1998. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting. Ann Thorac Surg 65:420-4.nGundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL. 1998. Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass. J Thoracic Cardiovasc Surg 115:1273-7.nHannan EL, Burke J. 1994. Effect of age on mortality in coronary artery bypass surgery in New York, 1991-1992. Am Heart J 128:1184-91.nJain U. 1995. Myocardial injury during reoperation for coronary artery bypass surgery. J Cardiothorac Vasc Anesth 9:389-94.nJones EL, Weintraub WS. 1996. The importance of completeness of revascularization during long-term follow-up after coronary artery operations. J Thorac Cardiovasc Surg 112:227-37.nScott R, Blackstone EH, McCarthy PM, et al. 2000. Isolated bypass grafting of the left internal thoracic artery to the left anterior descending coronary artery: late consequences of incomplete revascularization. J Thorac Cardiovasc Surg 120:173-84nStamou SC, Pfister AJ, Dangas G, et al. 2000. Beating heart versus conventional single-vessel reoperative coronary artery bypass. Ann Thorac Surg 69:1383-7.n[USBC] US Bureau of the Census. Statistical abstract of the United States: 1991. 1991. 111th ed.nWashington, DC: US Bureau of the Census. p 81. Verheul HA, Moulijn AC, Hondema S, Shouwink M, Dunning AJ. 1991. Late results of 200 repeat coronary artery bypass reoperations. Am J Cardiol 67:24-30.nWan S, Izzat MB, Lee TW, Wan IY, Tang NL, Yim AB. 1999. Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury. Ann Thorac Surg 68:52-6.nWeintraub WS, Craver JM, Cohen C, Jones EL, Guyton RA. 1991. Influence of age on results of coronary artery surgery. Circulation 84(suppl 3):226-35.nAwad WI, De Souza AC, Magee PG, et al. 1997. Re-do cardiac surgery in patients over 70 years old. Eur J Cardiothorac Surg 12:40-6.nBell MR, Gersh BJ, Schaff HV. 1992. Effect of completeness of revascularization on long-term outcome of patients with three vessel disease undergoing coronary artery bypass surgery: a report from the Coronary Artery Surgery Study (CASS) registry. Circulation 86:446-57.nBergsland J, Hasnain S, Lajos TZ, Salerno TA. 1998. Elimination of cardiopulmonary bypass: a prime goal in reoperative coronary bypass surgery. Eur J Cardiothorac Surg 14:59-63.nBlanche C, Khan SS, Chaux A, et al. 1999. Cardiac reoperations in octogenarians: analysis of outcomes. Ann Thorac Surg 67:93-8.nBuda AJ, Macdonald IL, Anderson MJ, Strauss HD, David TE, Berman ND. 1981. Long-term results following coronary bypass operation: importance of preoperative factors and complete revascularization. J Thorac Cardiovasc Surg 82:383-90.nCzerny M, Baumer H, Kilo J, et al. 2000. Systemic inflammatory response and myocardial injury in patients undergoing CABG with and without cardiopulmonary bypass. Eur J Cardiothorac Surg 17:737-42.nEdmunds LH, Stephenson LW, Edie RN, Ratcliffe MB. 1988. Open heart surgery in octogenarians. N Engl J Med 319:131-6.n
