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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2001 Dicembre;42(6):713-7
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.