Reinterventions for Recurrent Ischemic Heart Disease following a Successful First Re-Do Myocardial Revascularization: Predictors,Indications and Results

Abstract

Predictors for a reintervention following a successful first re-do surgical revascularization (CABG) were examined. Success and limitations of the reintervention procedures were evaluated. Between 3/88 and 3/95, 16.81% (302/1796) patients who had undergone a first re-do CABG surgery in the authors' center, required a reintervention. Graft angioplasty was performed in 158 (52.32%) patients and a second re-do CABG in 47.68% (n = 144). Graft angioplasty was preferred over surgery in patients aged 70 years or older (43% versus 24.3%, P < 0.001) and in patients with unstable angina (55.6% versus 33.3%. NS) or a Left Ventricular Ejection Fraction (LVEF) < 30% (34.8% versus 20%, P < 0.05). Re-do CABG was preferred over graft angioplasty for multivessel revascularization (3 ± 0.3 versus 1 ± 0.6, P < 0.001), proximal occlusive disease (P < 0.001) and for graft disease of a longer duration (7.18 ± 1.7 years versus 3 ± 0.6 years, P < 0.01). The independent predictors of a reintervention were (i) lack of arterial revascularization and (ii) inability to achieve a complete revascularization in a previous operation. The predictors of a failed graft angioplasty were diameter stenosis > 70% long occlusive lesions (multivariate), angulation, calcification and asymmetrical lesions (univariate). Failed graft angioplasty required a re-do CABG (n = 48: early 21. late 27). repeat graft angioplasty (n = 34: early 8. late 26) or transplant (n = 1). Recurrent symptoms following a second re-do CABG required a graft angioplasty (n = 6: early 2, late 4), a subsequent re-do CABG (n = 32) or a transplant (n = 4). Cumulative incidence of cardiac events at 1 month, and 1 and 8 years were: 20, 40.45 and 66.44% following graft angioplasty and 5.5, 10 and 56.55% following a second re-do CABG, respectively (P < 0.05). Actuarial survival at 1 month and 6 years following graft angioplasty were 97.15 and 77.22%, and 94.7 and 83.26% after a second re-do CABG, respectively (NS). Re-do CABG was more effective and durable. Graft angioplasty provided a good palliation in suitable cases and also postponed the need for a high-risk surgical intervention for more favorable conditions.