Abstract
Introduction. The number of patients in need of redo coronary artery bypass grafting (CABG) is constantly increasing throughout the world in connection with the increase in the number of primary operations of CABG. Repeated coronary bypass surgery remains complex and associated with a higher risk of complications and mortality compared with primary CABG. Many researchers emphasize that redo CABG on a beating heart provides protection and security bodies in redo CABG, reduces the incidence of major adverse events in hospital.
Objective – to compare the immediate and long-term results of redo CABG with and without cardiopulmonary bypass (CPB) in patients with ischemic heart disease with the return of myocardial ischemia after previously CABG.
Materials and methods. For the period from 2009 to 2018 time in Bakoulev National Medical Research Center for Cardiovascular Surgery made 83 operations redo CABG (43 On pump/40 Off pump).
Results. As a result of research we found that redo CABG Off pump has some advantages in comparison with redo CABG On pump, which consists in reducing the risk of new episodes of heart rhythm, infectious-inflammatory complications, and reduced need for blood products infusion and use Cell Saver by eliminating the adverse effects of CPB.
Conclusion. The obtained results indicate that redo CABG in general can be done with a low hospital mortality rate and high 1-, 5-year survival.
References
- Di Mauro M., Iaco A.L., Contini M., Teodori G., Vitolla G., Pano M. et al. Reoperative coronary artery bypass grafting analysis of early and late outcomes. Ann. Thorac. Surg. 2005; 79: 81–7. DOI: 10.1016/j.athoracsur. 2004.06.058
- Bockeria L.A., Sigaev I.Yu., Kazaryan A.V., Starostin M.V., Keren M.A., Morchadze B.D. et al. The early results of repeated coronary bypass surgery through alternative access. Russian Journal of Thoracic and Cardiovascular Surgery. 2019; 61 (1): 27–37 (in Russ.). DOI: 10.24022/0236-2791-2019-61-1-27-37
- Keren M.A., Kazaryan A.V. Recurrence ischemia after myocardial revascularization: the current state of the problem, risk factors, prognosis, tactics and results of repeated interventions. Annals of Surgery. 2017; 22 (5): 257–64 (in Russ.).
- Tugtekin S.M., Alexiou K., Kappert U., Esche H., Joskowiak D., Knaut M., Matschke K. Coronary reoperation with and without cardiopulmonary bypass. Clin. Res. Cardiol. 2006; 95: 93–8. DOI: 10.1007/s00392-0060335-5
- Mishra Y.K., Collison S.P., Malhotra R., Kohli V., Mehta Y., Trehan N. Ten-year experience with singlevessel and multi-vessel reoperative off-pump coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg. 2008; 135: 527–32. DOI: 10.1016/j.jtcvs.2007.10.019
- Ayyat K.S., Okamoto T., Deebis A.M., Abdelbary K.H., McCurry K.R. Reoperative coronary artery bypass grafting: review of changing pattern and outcomes. JOJ Case Stud. 2018; 8 (1): 555726. DOI: 10.19080/ JOJCS.2018.08.555726
- The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS). 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2018; 00: 1–96. DOI: 10.1093/ eurheartj/ehy394
- Noyez L., Eck F.M. Long-term cardiac survival after reoperative coronary artery bypass grafting. Eur. J. Cardiothorac. Surg. 2004; 25: 59–64. DOI: 10.1016/ s1010-7940(03)00656-0
- Sisillo E., Marino M.R., Juliano G., Beverini C., Salvi L., Alamanni F. Comparison of on pump and off pump coronary surgery: risk factors for neurological outcome. Eur. J. Cardiothorac. Surg. 2007; 31: 1076–80. DOI: 10.1016/j.ejcts.2007.02.015
- Dinh D.T., Lee G.A., Billah B., Smith J.A., Shardey G.C., Reid C.M. Trends in coronary artery bypass graft surgery in Victoria, 2001–2006: findings from the Australasian Society of Cardiac and Thoracic Surgeons database project. Med. J. Aust. 2008; 188: 214–7.
- Sabik J., Blackstone E., Gullinov M., Smedira N., Lytle B. Occurrence and risk factors for reintervention after coronary artery bypass grafting. Circulation. 2006; 114: 454–60. DOI: 10.1161/CIRCULATIONAHA. 105.001149
- Keren M.A., Sigaev I.Yu., Yarbekov R.R., Merzlyakov V.Yu., Kazaryan A.V., Nazarov A.A. et al. Coronary artery bypass grafting in diabetic patients with multivessel disease. Russian Journal of Thoracic and Cardiovascular Surgery. 2015; 2: 16–21 (in Russ.).
- Yaku H., Doi K. Redo coronary artery bypass grafting. Gen. Thorac. Cardiovasc. Surg. 2014; 62: 453–60. DOI: 10.1007/s11748-014-0426-6
- Vohra H.A., Bahrami T., Farid S., Mafi A., Dreyfus G., Amrani M. et al. Propensity score analysis of early and late outcome after redo off-pump and on-pump coronary artery bypass grafting. Eur. J. Cardiothorac. Surg. 2008; 33: 209–14. DOI: 10.1016/j.ejcts. 2007.11.011
- Shin Y.R., Lee S., Joo H.C., Youn Y.N., Kim J.G., Yoo K.J. Early and midterm outcome of redo coronary artery bypass grafting: on-pump versus off-pump bypass. Korean J. Thorac. Cardiovasc. Surg. 2014; 47: 225–32. DOI: 10.5090/kjtcs.2014.47.3.225
- Kara I., Cakalagaoglu C., Ay Y., Al Salehi S., Yanartas M., Anasiz H., Koksal C. Reoperative coronary artery bypass surgery: the role of on-pump and off-pump techniques on factors affecting hospital mortality and morbidity. Ann. Thorac. Cardiovasc. Surg. 2013; 19: 435–40. DOI: 10.5761/atcs.oa.12.02043
- Kazaryan A.V., Sigaev I.Yu., Starostin M.V., Morchadze B.D., Pilipenko I.V., Nazarov A.A. et al. Minimally invasive coronary surgery as a primary strategy for reoperative myocardial revascularization. In: The 26th Annual Meeting of the Asian Society for Cardiovascular and Thoracic Surgery conference proceedings. Moscow; 2018: 12.
- Yu Rim Shin, Sak Lee, Hyun Chel Joo, Young-Nam Youn, Jong Gun Kim, Kyung-Jong Yoo. Early and midterm outcome of redo coronary artery bypass grafting: On-pump versus Off-pump bypass. Korean J. Thorac. Cardiovasc. Surg. 2014; 47 (3): 225–32. DOI: 10.5090/kjtcs.2014.47.3.225
- Altınay L., Demirdas, E., Mungan U., Atılgan K., C, etin E., C, ic, eekc, ioˇglu F. Evaluations of factors affecting the outcome of redo coronary bypass surgery and long term results: A retrospective observational
study. J. Surg. Med. 2018; 2 (2): 130–3. DOI: 10.28982/josam.401707
- Loop F.D., Lytle B.W., Gill C.C., Golding L.A.R.,
Cosgrove D.M., Taylor P.C. Trends in selection and results of coronary artery reoperations. Ann. Thorac. Surg. 1983; 36: 380–8. DOI: 10.1016/s0003-4975(10) 60474-2
- Yau T.M., Borgr M.A., Weisel R.D., Ivanov J. The changing pattern of reoperative coronary surgery: trends in 1230 consecutive reoperations. J. Thorac. Cardiovasc. Surg. 2000; 120: 156–63. DOI: 10.1067/ mtc.2000.106983
- Van Eck F.M., Noyez L., Verheugt F.W.A., Brouwer R.M.H.J. Changing profile of patients undergoing redo-coronary artery surgery. Eur. J. Cardiothorac. Surg. 2002; 21: 205–11. DOI: 10.1016/s1010-7940(01)01106-x
- D'Ancona G., Karamanoukian H., Ricci M., Salerno T., Lajos T., Bergsland J. Reoperative coronary artery bypass grafting with and without cardiopulmonary bypass: determinants of perioperative morbidity and mortality. Heart Surg. Forum. 2001; 4: 152–8.
- Sepehripour A.H., Harling L., Ashrafian H., Casula R., Athanasiou T. Does off-pump coronary revascularization confer superior organ protection in re-operative coronary artery surgery? A meta-analysis of observational studies. J. Cardiothorac. Surg. 2014; 9 (1): 115. DOI: 10.1186/ 1749-8090-9-115
- Schutz A., Mair H., Wildhirt S.M., Gillrath G., Lamm P., Kilger E. et al. Re-OPCAB vs. Re-CABG for myocardial revascularization. Thorac. Cardiovasc. Surg. 2001; 49: 144–8. DOI: 10.1055/s-2001-14290
- Czerny M., Zimpfer D., Kilo J., Gottardi R., Dunkler D., Wolner E., Grimm M. Coronary reoperations: recurrence of angina and clinical outcome with and without cardiopulmonary bypass. Ann. Thorac. Surg. 2003; 75: 847–52. DOI: 10.1016/s0003-4975(02)04652-0
- Dewey T.M., Magee M.J., Acuff T., Prince S., Herbert M., Edgerton J.R., Mack M.J. Beating heart surgery reduces mortality in the reoperative bypass patient. Heart Surg. Forum. 2002; 5 (Suppl. 4): S301–16.
- Gerli C., Mantovani L., Franco A., De Luca M., Bergonzi P.C., Boroli F. et al. Redo coronary artery bypass grafting on the beating heart and transfusion needs. Minerva Anestesiol. 2006; 72: 985–93.
- Teodori G., Iaco A.L., Di Mauro M., Cini R., Di Giammarco G., Vitolla G. et al. Reoperative coronary surgery with and without cardiopulmonary bypass. J. Card. Surg. 2000; 15: 303–8. DOI: 10.1111/j.1540-8191.2000. tb01294.x
- Alamanni F., Pompilio G., Polvani G., Agrifoglio M., Zanobini M., Parolari A. et al. Off-pump redo coronary artery bypass grafting: technical aspects and early results. Heart Surg. Forum. 2002; 5 (Suppl. 4): S432–44.
- Yap C.-H., Sposato L., Akowuah E., Theodore S., Dinh D.T., Shardey G.C. et al. Contemporary results show repeat coronary artery bypass grafting remains a risk factor for operative mortality. Ann. Thorac. Surg. 2009; 87: 1386–91. DOI: 10.1016/j.athoracsur. 2009.02.006
About the authors
- Artak V. Kazaryan, Cand. Med. Sc., Senior Researcher, orcid.org/0000-0003-4277-7961
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Igor’ Yu. Sigaev, Dr. Med. Sc., Professor, Head of Department, orcid.org/0000-0002-1323-8072 Vadim Yu. Merzlуakov, Dr. Med. Sc., Professor, Head of Department, orcid.org/0000-0001-5638-3723 Mihkail D. Alshibaya, Dr. Med. Sc., Professor, Head of Department, orcid.org/0000-0002-8002-5525
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Margarita F. Abadzhyan, Cand. Med. Sc., Head of Department;
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Maksim V. Starostin, Cand. Med. Sc., Senior Researcher, orcid.org/0000-0003-4277-7961
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Milena A. Keren, Dr. Med. Sc., Researcher, Cardiologist, orcid.org/0000-0003-2428-1559
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Beka D. Morchadze, Cand. Med. Sc., Researcher, orcid.org/0000-0002-0385-2765
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Ivan V. Pilipenko, Cardiovascular Surgeon, orcid.org/0000-0002-2461-052X
