Comparison of Operative Mortality and Morbidity for Initial and Repeat Coronary Artery Bypass Grafting: The Coronary Artery Surgery Study (CASS) Registry Experience

https://doi.org/10.1016/S0003-4975(10)62312-0Get rights and content

Abstract

The National Heart, Lung, and Blood Institute's Coronary Artery Surgery Study (CASS) registry population was reviewed to allow comparison of operative mortality and morbidity rates for initial and repeat coronary artery bypass grafting (CABG) procedures. Standardized data collection was employed in CASS during patient entry (July 1, 1974, to May 31, 1979) and follow-up (ended November 30, 1982).

Initial CABG was performed on 9,369 patients. Mean follow-up was 60.5 months. Repeat CABG was required in 283 patients (3.0%). The mean interval between operations was 39.3 months. Individuals needing reoperation tended to be young (p < 0.0001) and female (p < 0.002) and to have less extensive coronary artery disease (p ≤ 0.0001), less left ventricular impairment (p < 0.0001), less evidence of congestive heart failure (p = 0.006), and fewer coronary vessel systems bypassed at the first operation (p < 0.0001).

Repeat CABG carried an increased risk of death compared with initial CABG (5.3% versus 3.1%, respectively; p < 0.05). However, the rates of perioperative myocardial infarction (6.4% for repeat and 5.8% for initial CABG) and of all surgical complications combined (30.6% versus 27.9%) were not significantly different from those at initial CABG.

References (13)

There are more references available in the full text version of this article.

Cited by (139)

  • Gene Therapy for the Prevention of Vein Graft Disease

    2015, Translating Gene Therapy to the Clinic: Techniques and Approaches
  • Saphenous vein graft intervention

    2011, JACC: Cardiovascular Interventions
  • Fistula From Aneurysmal Saphenous Vein Graft to Right Atrium Treated with Covered Stents

    2010, Heart Lung and Circulation
    Citation Excerpt :

    The hazards of repeated coronary artery surgery are greater than for initial procedures [32–36]. Patients are usually older and are more likely to have poor left ventricular function, more extensive native vessel disease and greater co-morbidities so that the postoperative mortality may be two to three times greater than it is for those undergoing their first operation [32,33,35–40]. One particular hazard is that a functioning internal mammary artery (IMA) graft may be damaged; the risk of this has been estimated to be 3–5% [34,36,39].

  • Does Re-operation have an Effect on Outcome Following Heart Transplantation?

    2007, Heart Lung and Circulation
    Citation Excerpt :

    For all these reasons the transplant recipient is expected to satisfy certain inclusion and exclusion criteria in order to be a successful candidate for the procedure.3–5 Previous cardiac operation is potentially a risk factor which may significantly influence the outcome of cardiac transplantation, especially since the technical difficulties of re-operation, in general, have been emphasised in several non-transplant reports in the past.6,7 The study aimed to identify and quantify the effect of previous cardiac operation on heart transplant patients regarding intra-operative, post-operative, and long-term outcomes using meta-analytical methodology.

View all citing articles on Scopus

Presented at the Twentieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 23–25, 1984.

The Coronary Artery Surgery Study was supported by the National Heart, Lung, and Blood Institute.

View full text