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THE JOURNAL OF CARDIOVASCULAR SURGERY

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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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