Thorac Cardiovasc Surg 2015; 63 - OP63
DOI: 10.1055/s-0035-1544315

Do Previous Cardiac Interventions Influence the Outcome of Subsequent Operative Cardiac Revascularization?

M. Pütz 1, C. Welz 1, P. Weiler 1, U. Klarmann 2, C.J. Preuße 1, W. Röll 1, A. Welz 1
  • 1Klinik und Poliklinik f. Herzchirurgie, Universitätsklinikum Bonn, Bonn, Germany
  • 2Universität Bonn, Institut für Medizinische Biometrie, Informatik und Epidemiologie, Bonn, Germany

Objectives: Patients suffering from coronary artery disease undergo, according to the guidelines, interventional or surgical treatment. However, there are only limited data of the influence of previous PTCA/stent implantation on the clinical outcome of patients who receive subsequent operative coronary revascularization.

Methods: In a retrospective analysis pre-, peri- and postoperative data of in total 509 patients were analyzed. In group 1, 143 patients with previous coronary intervention were enclosed, group 2 contained 366 patients who underwent primary surgical revascularization. All surgeries were performed on pump and under use of warm blood cardioplegia.

Results: Evaluation of preoperative basic parameters like age, gender distribution, body mass index, cardiovascular risk profile, NYHA class and left ventricular ejection fraction were not significantly different between the two groups. Patients of group 1 significantly more often suffered from myocardial infarctions (61% versus 41%, p < 0.001) and were on dual platelet inhibitors (44% vs 25%, p < 0.001). Intraoperatively there were no significant differences in average cross-clamp (68 minute. versus 69 minute.) and surgery times, as well as in the need of inotropic or mechanical support. Postoperative ventilation times, duration of inotropic support and ICU stay did not differ significantly between the two groups. Furthermore there was no increased drain loss or the need of re-thoracotomy in group 1. Also in terms of myocardial infarction, stroke, symptomatic transitory psychotic syndrome, arrhythmia, pneumonia and wound infection there were no significant differences between the two patient collectives. Most important mortalities (2.1% versus 2.7%) were nearly equal in both groups.

Conclusions: Even after previous coronary intervention(s) coronary artery bypass grafting can be performed safely, without increased mortality or a higher rate of postoperative complications.