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Eur J Cardiothorac Surg 1998;14:59-63
© 1998 Elsevier Science NL

Elimination of cardiopulmonary bypass: a prime goal in reoperative coronary artery bypass surgery¹

Center for Less Invasive Cardiac Surgery, The Buffalo General Hospital, State University of New York at Buffalo, New York, USA

Received 30 September 1997; received in revised form 1 April 1998; accepted 7 April 1998.

Corresponding author. Center for Less Invasive Cardiac Surgery, Department of Surgery, Buffalo General Hospital, 100 High Street,;Buffalo NY 14203,;USA;

Objective: The purpose of this study was to evaluate morbidity and mortality in reoperative coronary artery bypass surgery using the New York State database. Methods: Patients undergoing reoperative coronary artery bypass between January-1995 and December 1996 were included. Patients were operated using cardiopulmonary bypass (CPB group, n=184) or without cardiopulmonary bypass (non-CPB group, n=105) by surgeon preference. Groups were compared for preoperative risk factors, postoperative mortality and major complications. Results: Crude mortality was lower in the non-CPB group, despite a higher expected mortality, resulting in a risk-adjusted mortality of 1.3% versus 2.7% for the CPB group (NS). Of non-CPB patients, 91.4% were without complications, while only 72.1% of CPB patients (P<0.0001) were complication-free. Major complications were significantly reduced in non-CPB patients compared to CPB patients: stroke 0% versus 3.8% (P<0.04), cardiovascular complications 4.8% versus 15.8% (P<0.005), other major complications 1.9% versus 10.4% (P<0.007). Postoperative IABP support was needed in 1.9% of the non-CPB group patients and in 14.2% of the CPB group (P<0.0007). Conclusions: The main object of reoperative CABG is to relieve symptoms, since the survival benefit of the procedure has not been demonstrated. Performance of reoperative coronary artery bypass surgery without cardiopulmonary bypass significantly reduces morbidity. We conclude that cardiopulmonary bypass should be avoided whenever possible in reoperative coronary bypass surgery.

Key Words: Coronary artery bypass • Cardiopulmonary bypass • Mortality • Complication

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