Third-Time Coronary Artery Bypass Operations: Surgical Strategy and Results

Background. Increasingly, patients are returning for a second, third, and even fourth coronary artery bypass graft (CABG) procedure. Methods. This report reviews the in-hospital and long-term outcomes for 102 patients undergoing a third or fourth CABG at Emory University from December 1977 to April 1994. Results. The mean interval from the first to second CABG was 5.2 ± 3.5 years and from the second to the third CABG 6.8 ± 4.1 years. The mean age was 60 ± 9 years, 91% were male, 33% had hypertension, 16% diabetes, 86% class III or IV angina (Canadian Cardiovascular Society), 4.4% congestive failure (New York Heart Association), and 73% three-vessel disease. The in-hospital mortality rate was 9.8%, with a perioperative myocardial infarction rate of 8.8% and a stroke rate of 1.9%. Conclusions. These perioperative mortality and myocardial infarction rates are several times higher than those reported for initial revascularizations or first-time redo CABG operations. However, the 5- and 10-year survival rates of 79% and 59%, respectively, and a myocardial infarction-free survival of 62% at 5 years, the benefits of a third-time CABG procedure are apparent for this high-risk group of patients.