Late Outcome of Reoperative Coronary Revascularization on the Beating Heart

(#2000-4214 ... October 13, 2000)

Sotiris C. Stamou, MD, PhD, Albert J. Pfister, MD, Mercedes K.C. Dullum, MD, Steven W. Boyce, MD, Ammar S. Bafi, MD, Tracie Lomax, BS, Jorge M. Garcia, MD, Paul J. Corso, MD

Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center; Med-Star Research Institute, Washington, DC

ABSTRACT

Background: Reoperative (redo) coronary artery bypass grafting (CABG) is associated with a higher morbidity and mortality than first-time CABG. An off-cardiopulmonary bypass (off-pump) approach to redo CABG, however, may potentially benefit redo patients. The aim of the present report is to describe the early and long-term clinical outcome of patients who underwent off-pump redo CABG between July 1985 and January 1999 in our institution.

Methods: Redo patients (n = 138) represented 13% of patients who had off-pump CABG during the period of study (n = 1072) . Mean patient age was 63 ± 12 years, and 67% were men. Surgical approaches included median sternotomy (n = 93, 67%), anterior (n = 20, 15%) and lateral (n = 25, 18%) minimally invasive direct coronary artery bypass (MIDCAB).

Results: Operative mortality was 2% (n = 3). Target lesion re-intervention was 6% (n = 9) Actuarial survival at a mean period of follow-up of 2.5 ± 1 year (range: 1 month to 11 years) was 83%. Event-free survival (freedom from death, myocardial infarction, and repeat intervention) was 67%. Overall cardiac-related mortality was 10% (n = 14).

Conclusion: Off-pump redo CABG can be safely performed with a relatively low mortality rate and a low rate of target lesion revascularization.

AUTHOR/ARTICLE INFORMATION

Acknowledgment: We are indebted to Ellen Shair, MA, Research Writer/Editor, MedStar Research Institute, for her editorial contribution to this manuscript.

Submitted October 12, 2000; accepted October 13, 2000.

Address reprint requests to: Paul J. Corso, MD, Director of Cardiac Surgery, Washington Hospital Center, 106 Irving Street NW, Suite 316, South Tower, Washington, DC 20010, Phone: (202) 291-1430, Fax: (202) 291-1436, Email: pjc1@mhg.edu

Address correspondence to: Sotiris Stamou, MD, PhD, 2950 Van Ness Street, Apt 624, Washington, DC 20008, Phone: (202) 877-0277, Fax: (202) 291-1444, Email: sxs3@mhg.edu