Coronary by-pass reoperations without cardiopulmonary by-pass: The Israeli experience

Objectives. To evaluate results of coronary artery bypass grafting (CABG) reoperations without cardiopulmonary by-pass (CPB). Materials and methods. Thirty-two patients underwent CABG reoperation with CPB between December 1991 and December 1993. There were 29 (91%) males, and 3 (9%) females. Mean age was 62 ± 7 years. Five (16%) were operated on emergently, two (6%) of them during cardiogenic shock. Three (9%) were referred for operation up to two weeks following acute MI. Six (19%) had preoperative EF < 35%. Significant associated systemic diseases included previous CVA in two patients (6%), calcified aorta in two (6%), peripheral vascular disease in six (19%), renal failure in one (3%), and severe COPD in one (3%). Mean number of grafts/pt was 1.5 (range 1-3), and IMA was used in 26 (81%) of patients. Only nine patients (28%) received a graft to a circumflex marginal artery, six (66%) of whom were operated on through left thoracotomy. Results. Only two patients (6%) had low output syndrome postoperatively; one was supported with catecholamines, and the other with intraaortic balloon pump. Hospital stay was 6.1 ± 1.5 days (mean ± SD). Early unfavorable outcome included operative death in one patient (3.1%), non-fatal MI in two (6%), and sternal infection in one (3%). Follow-up (10 ± 5 months, mean ± SD) showed two late deaths (one cardiac, and one carcinoma), one (3%) non-fatal MI, and return of angina in three (9%) patients. Conclusions. CABG reoperations without CPB should be considered, particularly for revascularization of the LGD and RCA systems. Left thoracotomy is optional for patients with disease confined to circumflex and LAD systems.