Reoperation for coronary artery disease in the young: early and mid-term results

Abstract

Background: As the incidence of coronary artery disease (CAD) at young age is high in Asian countries, the number of coronary reoperations in this group of patients is increasing. The aim of this study was to define the incidence, risk factors and to discuss the methods of re-revascularization and early to mid-term outcomes in these patients.Methods: This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery (CABG) before the age of 45 years and underwent reoperation for recurrence of angina due to progression of native coronary artery disease and, or, graft occlusion. The data was also analyzed with regards to the risk factors contributing to the recurrence of the disease and the short to mid-term outcomes. During a six year period from January 1998 to October 2004, a total of 68 patients had reoperation for recurrence of angina. The mean interval of presentation following primary CABG was 12.48 _+ 3.11 years (ranged from 8 months to 16 years). Reoperation was performed under cardiopulmonary bypass (CPB) in 63 patients and in the remaining five patients on beating heart without using CPB.Results: Reoperation accounted for 4.6% of 2478 patients who underwent CABG between January 1998 through October 2004 at our institute. Among these 114 patients, 68 patients underwent primary CABG before the age of 45 years. These 68 patients received a total of 214 grafts (3.14 grafts per patient) of which 169 grafts were re-anastamosed to previously grafted target arteries. Left internal mammary artery was used in 61 patients (89.7%) who required graft to left anterior descending coronary artery at reoperation. The early mortality was 4.4% (3 out of 68). Two patients (2.94%) had perioperative myocardial infarction and two more patients were re-explored for mediastinal bleeding. Freedom from recurrence of symptom of angina at 2 and 4 years was 98.01%, 94.5% respectively.Conclusions: Redo CABG is associated with higher morbidity and mortality when compared to first-time CABG. Perioperative myocardial infarction and left ventricular dysfunction contribute significantly to the increased risk of redo CABG. (Ind J Thorac Cardiovasc Surg, 2005; 21: 199-203)

In-hospital and long-term outcomes of coronary artery bypass graft surgery in patients ≤ 45 years of age and older (from the KROK registry)

“…The recurrence of angina was a consequence of graft failure or progression of disease in native vessels. The number of grafts was 2.5 per patient at primary surgery and 3.1 at reoperation, which confirms progression of atherosclerosis in native arteries and failure of vein grafts in this group of patients [23]. In our material 55.4% of young patients obtained complete arterial revascularisation compared to 18.1% of older patients.…”

“…In the older papers, young adults involved patients 35 or 40 years old and younger [9-13, 15, 17, 18, 21]. In the more recent studies age 45 [16,23] and even 50 years [4] was the criterion of young age. This trend is probably a consequence of the decreasing number of young patients requiring CABG in recent years.…”

“…Progress in long-term outcomes is related to an improvement in surgical techniques, pharmacotherapy, and invasive cardiology. Use of arterial revascularisation is recommended especially in young patients with aggressive atherosclerosis, and it improves long-term results [10,13,23,26]. Sajja et al [23] analysed patients who had primary CABG mainly using venous grafts before the age of 45 years and required reoperation in the long-term follow-up period.…”

Trends of re-operative coronary artery bypass grafting: A two-decade experience

“…However, PCI remains the preferred modality due to its technical ease and lesser mortality than redo CABG. 1,2 This has reduced the prevalence of redo CABG from 4.6% 3 to < 2% 4 in the Indian scenario. Through this study, we aim to analyze the evolving trends in the prevalence of redo CABG, post-PCI redo CABG, preoperative patient characteristics, and their effect on the outcomes of patients undergoing redo CABG.…”