Reoperative Coronary Artery Bypass Grafting With and Without Cardiopulmonary Bypass: Determinants of Perioperative Morbidity and Mortality

(#2000-1080 ... December 8, 2000)

Giuseppe D'Ancona, MD, ¹ Hratch Karamanoukian, MD, ¹ Marco Ricci, MD, ² Tomas Salerno, MD, ² Thomas Lajos, MD, ¹ Jacob Bergsland, MD¹

¹ The Division of Cardiothoracic Surgery at Buffalo General Hospital and State University of New York at Buffalo, Buffalo, New York
² University of Miami Medical School at Jackson Memorial Hospital, Miami, Florida

ABSTRACT

Background: This retrospective study evaluates perioperative results of reoperative coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass (CPB).

Methods: From January 1995 to March 1999 reoperative CABG was performed on 581 patients: 307 (52.84%) patients were operated upon on-CPB and 274 (47.16%) off-CPB. Median sternotomy was used in all patients on-CPB. Median sternotomy or alternative surgical approaches were used in the off-CPB group. Data was retrospectively reviewed. To identify the variables independently related to perioperative mortality and adverse outcome, multivariate analysis was performed in the overall population of 581 patients.

Results: Preoperative risk factors were comparable in the two groups. Critical lesions of the right and left circumflex coronary artery were more common in the on-CPB group (p < 0.005). A total of 2.7 grafts/patient was performed in the on-CPB group versus 1.3 grafts/patient in the off-CPB group (p = NS). Freedom from postoperative complications was higher in the off-CPB group (72% versus 90.9%, p < 0.005). Perioperative stroke and respiratory failure rates were more common in the on-CPB group (3.9% versus 0.7% and 5.9% versus 2.2% respectively, p < 0.005). Actual mortality was 5.9% in the on-CPB group and 3.6% in the off-CPB group (p = NS). Risk adjusted mortality was 2.2% and 1.3% in the on-CPB and off-CPB groups respectively. Although CPB was found to be independently related to adverse outcome (odds ratio (OR) = 2.89, p-value < 0.005), no correlation was found between mortality and CPB.

Conclusions: Avoidance of CPB independently reduces adverse outcomes in reoperative CABG without affecting mortality rate.

AUTHOR/ARTICLE INFORMATION

Submitted December 5, 2000; accepted December 8, 2000

Address correspondence and reprint requests to: Hratch Karamanoukian, MD, Kaleida Health-Buffalo General Hospital Site, 100 High Street, Buffalo, NY 14203, Phone (716) 859-1080, Fax (716) 859-4687, Email: lisbon5@yahoo.com