Redo Coronary Artery Bypass Grafting with and without Cardiopulmonary Bypass in the Elderly

Objectives:

Morbidity and mortality rates rise with increasing age in patients undergoing conventional redo coronary artery bypass grafting (CABG). The aim of this study was to compare our experience of minimal tissue dissection and target vessel revascularization without cardiopulmonary bypass (CPB) with the standard procedure of total dissection of the heart and complete revascularization with CPB for a population of elderly patients undergoing elective redo coronary artery CABG.

Methods:

We retrospectively analyzed morbidity, mortality, and functional status of 47 patients older than 75 years who underwent redo CABG between January 1995 and June 2002. Thirty-one patients underwent redo CABG with CPB, and 16 patients underwent redo CABG without CPB. Follow-up end points were defined by patient survival, freedom from recurrence of angina (Canadian Cardiovascular Society ÄCCSÅ score), freedom from rehospitalizations and reinterventions, and the need for antianginal medication.

Results:

There were 2 perioperative deaths (2 in the CPB group versus 0 in the group without CPB; P = .151). Nonfatal myocardial infarction occurred in 3 patients (3 in the CPB group versus 0 in the group without CPB; P = .082). Major adverse cardiac events occurred in 5 patients (5 in the CPB group versus 0 in the group without CPB; P = .058). At the time of follow-up, the mean CCS score of patients who underwent redo CABG with CPB was 1.5 ± 0.8 and was 1.6 ± 0.7 for patients who underwent redo CABG without CPB (P = .432). The rates of angina recurrence (16% with CPB versus 13.3% without CPB; P = .243), use of nitrates (8.7% with CPB versus 14.3% without CPB; P = .542), and survival (89% with CPB versus 93% without CPB; P = .238) were very comparable for the two groups.

Conclusions:

In this high-risk subgroup of patients, those patients who underwent target vessel revascularization without CPB showed a trend toward a lower rate of major adverse cardiac events, and this procedure seems promising with regard to long-term outcome. Therefore, target vessel revascularization may be offered liberally to elderly patients who are at high risk in surgeries involving complete revascularization with CPB. Further studies are needed to elucidate the long-term outcome of target vessel revascularization for elderly patients undergoing redo CABG.