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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2000 October;41(5):703-8

lingua: Inglese

Coronary reoperations: indications, techniques and operative results. Retrospective study of 240 coronary reoperations

Grinda J. M., Zegdi R., Couetil J. P., Chauvaud S., Deloche A., Fabiani J. N., Carpentier A.

From the Cardiac Surgery Department Broussais Hospital, Paris University, Paris VI


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Background. We ­review ­twelve-­year expe­ri­ence ­with cor­o­nary reop­er­a­tions so as to bet­ter iden­ti­fy indi­ca­tions, tech­niques and ­results.
Methods. Between January 1986 and March 1998, 240 cor­o­nary reop­er­a­tions (228 ­redux, 12 tri­dux) ­were per­formed. There ­were 223 ­male and 17 ­female ­patients, ­with a ­mean age of 63.6±7.9 ­years at the ­time of reop­er­a­tion. Mean ­time inter­val ­between oper­a­tions was 10±4.8 ­years. Symptomatology con­sist­ed of: ­stable recur­rent angi­na (40%), ­unstable (57%), or con­ges­tive ­heart fail­ure (3%). Pathological fea­ture of the pri­mary ­grafts was impli­cat­ed in 95% of cas­es and ather­o­ma ­sole pro­gres­sion ­over ­native net­work in 5% of cas­es. During reop­er­a­tions 521 (2.2±0.8/­patient) ­bypass [­venous (40%), arte­ri­al (60%)] ­were per­formed as ­well as 15 asso­ciat­ed pro­ce­dures.
Results. Operative mor­tal­ity rep­re­sent­ed 10% (n=24). Causes of ­death includ­ed ­infarct (7), ­left ven­tric­u­lar fail­ure (12), ­rhythm dis­or­ders (2), med­i­as­tin­itis (1) and mul­ti-­organ fail­ure (2). Mortality ­risk fac­tors ­were oper­a­tion ­date (16.6% ­before 1992 and 7.4% ­after, p=0.03), age (13.1% ­after 60 ­years old, 2.7% ­before, p=0.01) ­time inter­val ­between inter­ven­tion (12% ­after 8 ­years, 4% ­before, p=0.05) and ante­ro­grade car­di­o­ple­gia ­only (11.8% ver­sus 4.5% ­when a com­bined ante­ro­grade and ret­ro­grade ­access was ­used, p=0.06). Morbidity was 31% (71/240). Among the sur­vi­vors 169 ­patients (78%) did not expe­ri­ence any com­pli­ca­tion.
Conclusions. Thanks to a bet­ter med­i­co-sur­gi­cal man­age­ment, the mor­tal­ity ­rate of cor­o­nary reop­er­a­tions is stead­i­ly decreas­ing.

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