Objective: Patients undergoing reoperative coronary artery bypass suffer from increased mortality and morbidity rates as compared to primary coronary bypass. The experience in applying off-pump techniques to coronary reoperations is limited. In this report, we report our experience in multivessel reoperative off-pump coronary bypass.
Methods: Between January 1996 and December 2005, coronary reoperations were performed on 538 patients’ at this institution, of which 332 patients underwent multivessel reoperative off-pump coronary artery bypass and 206 patients underwent reoperative coronary bypass using conventional techniques. Patients undergoing single vessel revascularisation or thoracotomy were excluded. The 2 groups were similar in preoperative characteristics. Data was collected retrospectively regarding the preoperative, intra-operative and postoperative clinical course of all patients
Results: Early mortality in the off pump group was significantly lower than for those undergoing
conventional coronary bypass (3.3% versus 7.8%, p=0.036). Peri-operative myocardial
infarction was also lower in the off-pump group (4.8% versus 7.3%, p<0.025). The off-pump group had less transfusion needs (p=0.001), less need for prolonged ventilation (p=0.001) or prolonged inotropic support (p<0.001), and had shorter intensive care (p<0.001) and hospital stays (p<0.001). The average number of grafts per patient was significantly higher in the conventional group (mean 2.51+0.66 versus 1.75+0.74, p<0.001).
Conclusions: This ten-year experience of re-operative coronary bypass confirms that currently coronary reoperative can be performed either as redo-OPCABG or redo-CABG with low mortality and morbidity. Patients who undergo redo-OPCABG have a lower mortality rate and smoother course in hospital than those undergoing redo-CABG, at the cost of a less complete revascularisation