Reoperation in symptomatic patients after direct coronary artery revascularization.

Seventy-nine patients underwent 85 reoperations to revascularize the myocardium at intervals from 2 days to 5 years (mean 13 months) after primary direct revascularization procedures. A total of 122 bypass grafts including 43 individual veins, 43 double or triple sequential veins, and 17 internal mammary arteries (IMA) were utilized. Failure of previous bypass grafting was the most common reason for recurrent symptoms, partially due to the high failure rate of radial artery segments used as bypass conduits. One operative and three late deaths have occurred. Coronary arteriography, performed after reoperation (mean 14 months) in 15 patients, revealed a graft patency rate of 68 percent. Significant differences in postoperative complications between the first and subsequent operation could not be demonstrated. Combined nonfatal perioperative infarctions with the first and subsequent operations decreased ventricular function and probably contributed to the improved symptomatic state of some patients. It is concluded that good symptomatic relief and long-term survival can be achieved by reoperation in selected patients who have recurrent symptoms after primary direct myocardial revascularization.