Reoperation for recurrent coronary artery disease: causes, indications, and results in 168 patients.

Of the 13,049 patients who underwent coronary artery bypass surgery, 168 underwent a second or third operation because of the failure of the first. The early mortality was eight of 168. Good to excellent results were obtained in 141 patients. The cumulative survival rate was 82% at six years. Graft failure and the progression of atherosclerosis to a critical lesion were the most common reasons for reoperation, and perioperative myocardial infarction and incomplete initial operation were the least common. Long-term follow-up showed a peak of graft failure and progression of disease in nongrafted arteries at three years and decreased thereafter. Progression of distal disease in grafted arteries was not temporally related and was uncommon. Thrombosis of the vein graft could be related most frequently to the distal circulation rather than the vein graft itself.