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Long-term Follow-up After Coronary Artery Bypass Grafting Reoperation^*

* From the Post-Cardiac Surgery Follow-up Clinic (Drs. Shapira, Isakov, and Heller), Internal Medicine H (Dr. Topilsky), and Internal Medicine T (Dr. Pines), the Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: Coronary artery bypass grafting (CABG) reoperation is being performed with increasing frequency.

Objective: To determine the clinical outcome and the long-term results of a second CABG.

Setting: An 1100-bed urban university-affiliated hospital.

Design: Retrieval of data on selected parameters from medical records before surgery and prospective follow-up afterwards.

Patients and methods: We studied the outcomes of 498 consecutive patients who underwent CABG reoperation in our institution from January 1978 to December 1989 and who were followed postoperatively. Their perioperative mortality, morbidity, and long-term follow-up results were re-evaluated. The end points of the study were December 1997, 15 years of follow-up, or the patient's death.

Results: The perioperative mortality rate was 3%. The cumulative survival rates were 90.1%, 74%, and 63.4% at the 5-year, 10-year, and 15-year follow-ups, respectively. The cardiac event-free survival rates were 91.5%, 83.4%, and 67.8% at the 5-year, 10-year, and 15-year follow-ups, respectively. The risk factors adversely affecting long-term survival were advanced age, hypertension, and a low left ventricular ejection fraction (LVEF).

Conclusions: The long-term results of cumulative survival and cardiac event-free survival in patients who underwent CABG reoperation are good. Although this reoperation is safe overall, advanced age, hypertension, and a decreased LVEF significantly increase the surgical risk.

Key Words: cardiac-event free • coronary artery bypass grafting • long-term follow-up • reoperation • survival

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