Reoperation for coronary graft failure: clinical and angiographic results in 43 patients.

Reoperation because of early or late coronary graft failure was performed in 43 patients who were part of a group of 1,985 patients operated on for coronary artery disease and followed for up to 7 years. Considerable variation in the results was noted depending on whether the patients were symptomatic or not before reoperation. Of the symptomatic patients, 85% were asymptomatic late (30 months) after reoperation whereas of those patients reoperated on despite the apparent lack of symptoms, 71.5% remained free from angina later on. Moreover, patency rate was high (94.4% or 17/18 grafts) in the first group and much lower (38.4% or 5/13 grafts) in those reoperated on solely on the basis of an early angiogram showing malfunctioning grafts. Patency rate was higher when the graft was totally replaced (92.3% or 12/13 restudied) rather than repaired simply through interposition of a segment of vein (37.5% or 3/8). It is apparent that results of reoperation in symptomatic patients are identical to those of an initial revascularization. On the other hand, patients who are asymptomatic despite early evidence of malfunctioning grafts should be reoperated on only when optimal angiographic conditions are present, that is, a coronary artery that is a good size, severely narrowed, and supplying a large myocardial area.