Reoperaciones coronarias: análisis retrospectivo de 16 años de experiencia / Coronary artery bypass grafting reoperation: a 16 years retrospective analysis

RESUMO

Background: Coronary artery bypass grafting (CABG) reoperation is being performed with increasing frequency. Aim: To assess the early and long term results of coronary reoperations in our institution and to identify prognostic factors. Patients and methods: 214 patients subjected to coronary reoperations between 1983 and 1999 were retrospectively studied. Results: Mean age was 64.2 years (range 42-79 years), 202 (94.4 per cent) were male and 12 (5.6 per cent) female. The mean interval between the operations was 125.7 months (range 6-252 months). 10 (4,6 per cent) were emergency surgeries. Overall operative mortality was 5.6 per cent (11 deaths) and in 5 patients (3.4 per cent) a perioperative myocardial infarction was noted. Univariate analysis identified moderate or severe left ventricular failure (p=0.048) as predictor of increased operative mortality, meanwhile age over 75 years (p=0.02) and moderate or severe left ventricular failure (p=0.01) were identified as predictors of increased in hospital mortality in the multivariate analysis. Follow up of in hospital survivors (mean interval 65 months, range 4 to 190 months) documented a 5 years survival rate of 82.9 per cent, a 10 years survival rate of 73.1 per cent and a 15 years survival rate of 53.4 per cent. Moderate or severe left ventricular failure (p <0.0001) and emergency surgeries (p=0.007) were identified as factors influencing the late survival in the stepwise logistical regression analysis. Multivariate analysis identified left ventricular failure (p=0.01) and peripheral vascular disease (p=0.01) as predictors of decreased late survival. Conclusions: Coronary reoperation has a low mortality in patients with a normal ventricular function and also has an excellent overall and disease free survival in the first 10 years of follow up. Left ventricular function is an independent risk factor increasing in hospital and late mortality