Prevalence and Outcome after CABG in Patients with History of Prior CABG surgery

 

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Objectives: Redo coronary surgery is more challenging than primary operations. We ought to find out if redo cardiac surgery for coronary artery bypass grafting (CABG) is associated with an adverse perioperative outcome.

Methods: From 01/2015 to 05/2017, a total of 7,352 consecutive patients undergoing isolated CABG were included in the retrospective multicenter E-CABG registry. Patient characteristics, intraoperative and follow-up data were compared between patients undergoing primary or redo CABG surgery.

Result: Mean age was 67.4 ± 9.4 years. Out of 39 patients with prior cardiac surgery 32 (0.4%) received prior CABG. The EuroSCORE II was higher in redo CABG patients than in patients undergoing primary cardiac surgery (redo vs. primary: 8.8 ± 11.0 vs. 2.8 ± 4.1, p < 0.001). There was no statistical difference in the preoperative rates of extracardiac arteriopathy (redo: 25.0% (n = 8), primary: 23.3% (n = 1706), p = 0.82), chronic kidney disease (redo: 12.5% (n = 4), primary: 6.1% (n = 445), p = 0.13), impaired left ventricular ejection fraction (LV-EF <51%; redo: 28.1% (n = 9), primary: 29.2% (n = 2135), p = 0.89) or the prevalence of diabetes (redo: 18.8% (n = 6), primary: 31.2% (n = 2285), p = 0.128).

Redo patients more frequently underwent OPCAB surgery (redo: 46.9% (n = 15), primary: 20.4% (n = 1495), p < 0.001) and received fewer distal anastomoses (redo vs. primary: 1.88 ± 0.94 vs. 2.70 ± 0.94 anastomoses, p < 0.001). Also, operation times were comparable between the groups (redo vs. primary: 259.3 ± 104.2 vs. 238.6 ± 73.8 minutes, p = 0.120).

Our data did not show significant differences in the frequency of postoperative mechanical circulatory support (redo: 3.1% (n = 1), primary: 4.9% (n = 355), p = 1.0), re-sternotomy for bleeding (redo: 0.0% (n = 0), primary: 2.6% (n = 193), p = 1.0), type V myocardial infarction (redo: 3.1% (n = 1), primary: 6.0% (n = 442), p = 1.0), stroke (redo: 3.1% (n = 1), primary: 0.8% (n = 59), p = 0.33) or 30-day mortality (redo: 0.0% (n = 0), primary: 1.7% (n = 127), p = 1.0).

Conclusion: Redo-CABG was rare in this consecutive multicenter E-CABG cohort. The use of fewer anastomoses in the redo group may be attributed to the need for selective revascularization of vessels which are not amenable to native-vessel PCI. Despite the higher EuroSCORE II in patients undergoing redo surgery we did not observe an increase in adverse events postoperatively or in mortality justifying this procedure in selected patients.

Publication History

Article published online:
19 February 2021

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