ABSTRACT
BACKGROUND: As the experience of coronary artery bypass grafting (CABG) has been accumulated, the number of reoperation after CABG is increasing. We analyzed our clinical experience of redo-CABG. MATERIAL AND METHOD: Fourteen patients who underwent redo-CABG between Jan. 1994 and Dec. 2002 were included in this study. The mean period from the first operation to reoperation was 66+/-56 (3~57) months, and the average ages were 62.8+/-8.7 (51~8) years. The survivors were followed up 39+/-29 (4~01) months postoperatively. Indications of reoperation were stenosis or occlusion of previous grafts in 11 patients, progression of native coronary artery disease in one patient, and both etiologies in two patients. RESULT: There were two in-hospital mortalities (14.3%) resulting from low cardiac output syndrome. Postoperative morbidities were perioperative myocardiac infarction in 2 patients (14.3%), mediastinitis in one patient (7.2%), duodenal perforation in one patient, ischemic necrosis of the lower extremity in one patient, gastric perforation after mesenteric infarct in one patient, delayed brain infarct in one patient, and intraoperative splenic rupture in one patient. There was one late mortality at six months postoperatively during the follow up. There was no angina recurrence during the follow up. CONCLUSION: Although redo CABG demonstrated relatively high operative mortalities and morbidities, postoperative status and clinical outcome of the survivors were favorable.
Subject(s)
Humans , Brain , Cardiac Output, Low , Constriction, Pathologic , Coronary Artery Bypass , Coronary Artery Disease , Coronary Vessels , Follow-Up Studies , Hospital Mortality , Infarction , Lower Extremity , Mediastinitis , Mortality , Necrosis , Recurrence , Reoperation , Splenic Rupture , Survivors , TransplantsABSTRACT
It is now widely accepted that the complete arterial coronary revascularization has better short and long term results compared to coronary bypass surgery using arterial graft mixed with vein graft mainly due to its superior patency rate. However, sometimes the internal thoracic artery and other conventionally used grafts might be unavailable or it may require caution in using bilateral internal thoracic artery especially in diabetic patient because of the possible risk of the mediastinitis or other associated morbidities. Moreover, there could also be a shortage for arterial graft in case of coronary reoperation. We report our first three cases using thoracodorsal artery(TDA) as an alternative graft in complete arterial coronary revascularization.
Subject(s)
Humans , Arteries , Mammary Arteries , Mediastinitis , Reoperation , Transplants , VeinsABSTRACT
BACKGROUND: Central nervous system complication after coronary artery bypass grafting (CABG) is one of the major prognostic determinants and the use of the cardiopulmonary bypass(CPB) may increase the incidence of this devastating complication. In this study, the outcomes after off-pump CABG were studied and compared with those following the conventional CABG using CPB. MATERIAL AND METHOD: Among the consecutive isolated CABG's performed in SNUH during Feb. 1995 and Jun. 1999, 338 coronary artery bypass grafting were divided into two groups. 223 patients underwent CABG using the CPB(Group I), and 115 patients underwent CABG without CPB(OPCAB)(Group II). All patients enrolled in this study received extensive preoperative examinations including thorough neurologic examination before and after surgery, transcranial doppler study, carotid duplex ultrasonography, and magnetic resonance angiography if necessary. Central nervous system(CNS) complications were defined as stroke, seizure, metabolic or hypoxic encephalopathy and transient delirium after surgery. RESULT: There were 61 cases(27.3%) who developed postoperative CNS complication in Group I, whereas 8 cases(7.0%) of CNS complications developed postoperatively in group II(p<0.05). Statistically significant predictors of postoperative CNS complications in group I were age and the use of cardiac assist devices perioperatively. CONCLUSION: This study suggested that omitting the use of CPB in CABG resulted in significant decrease of the postoperative CNS complications. OPCAB should be more widely applied especially to the elderly who have preexisting cerebrovascular disease.
Subject(s)
Aged , Humans , Cardiopulmonary Bypass , Central Nervous System , Coronary Artery Bypass , Coronary Vessels , Delirium , Hypoxia, Brain , Incidence , Magnetic Resonance Angiography , Neurologic Examination , Postoperative Complications , Seizures , Stroke , UltrasonographyABSTRACT
Objective To determine the lesion characteristics and effect of intervention on diseased grafts in older patients. Methods Thirty-eight patients with angina after coronary artery bypass grafts (CABG) were enrolled into Nanjing First Hospital. Interventions were performed after multiple-view angiogram and formal consent from relatives received. Angiographic follow-up was conducted within 6 months. Cardiac events were recorded during the 6-month clinical follow-up. Results Of the 38 patients (36 males and 2 females), the average age was 63.2 years. Angina occurred 11.5 months after CABG. Angipgrams were performed 4.8 years after CABG. Diabetes was complicated in 10 cases and old myocardial infarction in 8, respectively. Left ventricular ejection fraction was increased from 52%?10% to 58%?14% (P