ABSTRACT 17

CORONARY ARTERY REOPERATION WITH AND WITHOUT CARDIOPULMONARY BYPASS

Mario Chiavarelli, Konstantin Tarashansky, Mario Sabado, Israel Jacobowitz. SUNY-UHB and Maimonides Medical Center, Brooklyn, NY

Early mortality and complication rate is higher in CABG reoperation. The effect of cardiopulmonary bypass (ON-CABG) was compared to off-pump cases (OFF-CABG) retrospectively.

Eighty-five of 1010 consecutive patients underwent redo CABG from January 1998 through September 2000. Data were examined by univariable and multivariable analyses.

Sixty-six patients (78%) underwent OFF-CABG. In-hospital mortality was 4.8% for OFF-CABG and 26.7% for ON-CABG (χ²=5.32; p=0.021). Probability of in-hospital death was 9.2% versus 11.1% (t=0.65; p=0.517); risk adjusted mortality rate was 1.3% versus 6.0%. Univariable analysis demonstrated an association between early mortality and the following preoperative risk factors: multiple MIs (p=0.009), intravenous nitroglycerin within 24 hours (p=0.049), congestive heart failure at the same admission (p=0.049), malignant ventricular arrhythmia (p=0.0008). Significant postoperative events included: sepsis (p=0.0008), G-I bleeding (p=0.029), renal failure (p<0.0001), respiratory failure (p=0.0077). The following variables were retained in the multivariable model: multiple MIs (p=0.0005), intravenous nitroglycerin (p=0.0014), congestive heart failure (p=0.0014), malignant ventricular arrhythmia (p<0.0001), and postoperative renal failure (p<0.0001).

OFF-CABG offers a better survival in reoperation, which could not be explained by patient selection. Preoperative cardiac status and postoperative renal failure have a prevalent impact on early mortality.