Author/Editor     Radovanović, Ninoslav
Title     Risk and limits in re-do coronary surgery today - personal experience
Type     članek
Source     In: Pajer Z, Štiblar-Martinčič D, editors. International symposium on cardiovascular diseases. Proceedings of the 29th memorial meeting devoted to prof. dr. Janez Plečnik; 1998 Dec 3-5; Ljubljana. Ljubljana: Medical faculty, Institute of histology and embryology,
Publication year     1998
Volume     str. 129-42
Language     eng
Abstract     Within the past 24 years 312 pts underwent re-do coronary surgery. There were 277 male (89%) and 37 female (11%) patients, with the mean age of 58.5 years (37-75). The group of 138 pts (44%) were reoperated by the same surgeon, with mean time interval from the first operation of 7.3 years and 174 pts (56%) were from other institutions and surgeons, with the mean time interval from the firt operation of 5.2 years. The main reasons for repeated coronary evascularisation were: progression of native coronary disease in 245 pts, phlebosclerosis or bad choice of vein graft in 148 pts, operative technique erros in 44 pts, incomplete revascularisation in 12 pts. and postoperative pericarditis (Dressler) in 7 pts. In 43 pts (14%) associated lesions were observed: mitral ischemic regurgitation (30 pts.), aortic valve disease (5 pts.), mitral stenosis (2 pt.), left ventricle aneurysm (4 pts.) and carotid stenosis (2 pts.). Postoperative mortality - 30 days (PM) was 6.7% (21 pts.). Causes of death were: low cardiac output (10 pts.), malignant heart rhythm disturbances (7 pts), renal insufficiency (1 pt), sudden death (1 pt), pulmonary infection (1 pt) and hepato-renal insufficiency (1 pt). In 163 pts (52%) endarterectomies (E) on one or several coronary vessels were performed, because of progression of native coronary disease. In this group of patients PM was 4.9%. Out of the total number of 312 pts, 112 (36%) had ejection fraction (EF) lower than 30%. Twenty five had EF between 15 and 20%, 37 pts had EF between 21 and 25% and 50 pts had EF between 26 and 30%. PM in this high-risk group of the patients was 8.0% (9 pts). This clinical experience shows evolutive character of coronary arteries disease and progression of pathologic process in native circulation, after the first revascularisation.(Abstract truncated at 2000 characters)
Descriptors     CORONARY DISEASE
ENDARTERECTOMY
REOPERATION
POSTOPERATIVE COMPLICATIONS
RISK FACTORS