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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2001 December;42(6):713-7

language: English

Mortality and morbidity in reoperation comparing to first intervention in coronary revascularization

Merlo C., Aidala E. *, La Scala E., Carrieri L., Paglia I., Drago S., Gagnor A., Pansini S., Bergerone S., Di Summa M., Trevi G.

From the Cardiology Division
*Cardiac Surgery Division University of Turin Molinette Hospital, Turin, Italy


Background. Coronary ­artery reop­er­a­tion rep­re­sents ­about 20% of cor­o­nary ­artery oper­a­tions. In ­this ­study we com­pared mor­tal­ity and mor­bid­ity of ­first inter­ven­tion and ­redo oper­a­tion.
Methods. Experimental ­design: a ret­ro­spec­tive ­study. Setting: patients who under­went cor­o­nary ­artery reop­er­a­tions in a University Cardiac Surgery Division in 1991-1994. Patients: our clin­i­cal sur­vey was com­posed of two ­groups: ­group A includ­ed 44 con­sec­u­tive ­patients (­mean age 60±7 ­years, ­males/­females=41/3) who under­went a cor­o­nary ­artery reop­er­a­tion in the ­years 1991-1994 at the University Cardiac Surgery Division of Turin; ­group B includ­ed 344 ­patients (­mean age 58±8 ­years, ­males/­females=289/55) ran­dom­ly select­ed ­among ­those who under­went a ­first cor­o­nary oper­a­tion in the ­above indi­cat­ed peri­od of ­time and cen­tre. All ­patients had angi­na pec­tor­is refrac­to­ry to max­i­mal med­i­cal ther­a­py. Interventions: all ­patients under­went a cor­o­nary ­artery oper­a­tion in extra­cor­po­real cir­cu­la­tion (ECC), ­under ­mild hypo­ther­mia (30-32°C), dur­ing a sin­gle aor­tic ­clamp peri­od, ­with ante­grade ­cold crys­tal­loid car­di­o­ple­gia (St. Thomas). Measures: comparison of clin­i­cal pre­op­er­a­tive fea­tures, ­risk fac­tors and post­op­er­a­tive mor­tal­ity and mor­bid­ity ­between the two ­groups.
Results. In reop­er­at­ed ­patients we ­observed a great­er ­mean akin­e­sis ­score (p<0.001) and ­severe ­left ven­tric­u­lar dys­func­tion pres­ence (p=0.014). Reoperation mor­tal­ity was 11.4% ­against ­first oper­a­tion mor­tal­ity of 3.2% (p=0.03). Female gen­der (p=0.03), ­intra-aor­tic bal­loon coun­ter­pul­sa­tion ­need (p=0.002), adren­a­line use (p=0.004) and low car­diac out­put syn­drome (p=0.007) ­were all per­i­op­er­a­tive ­risk fac­tors in ­group A.
Conclusions. Coronary ­artery reop­er­a­tion ­involves a high­er mor­tal­ity and mor­bid­ity com­pared to the ­first oper­a­tion, espe­cial­ly relat­ed to the ­reduced ­left ven­tric­u­lar func­tion ­which char­ac­ter­is­es the pop­u­la­tion ­that under­goes reop­er­a­tion.

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