'No touch' dissection, antegrade-retrograde blood cardioplegia, and single aortic cross-clamp significantly reduce operative mortality of reoperative CABG

Abstract

Background: We assessed the improvement in total and cardiac-related operative mortality in 131 consecutive patients after reoperative coronary artery bypass surgery (CABG).

Methods and results: The patients were divided into two consecutive groups, A (1988 to 1989) and B (1990 to 1993), on the basis of the implementation of alternative techniques of myocardial protection. The techniques in group B included the "no touch" technique or minimal dissection before bypass, routine femoral artery and vein exposure, and frequent cannulation for cardiopulmonary bypass and antegrade and retrograde blood cardioplegia, with all vascular anastomoses (proximal and distal) performed with a single aortic cross-clamp and cardioplegic arrest. Cardiac mortality from low cardiac output or myocardial infarction was 15% versus 0%, P = .002. Multivariate analysis of demographics, perioperative risk factors, and myocardial protection techniques revealed that only membership in group A and the requirement for an intra-aortic balloon counterpulsation independently predicted mortality. By univariate analysis, group A had significantly more patients with three-vessel disease and patients who required urgent or emergent procedures, but analysis of patients in these subgroups also demonstrates a significant reduction in mortality in the "no touch" patients (group B). Although no technique was independently responsible for reduced operative mortality, all the myocardial protection techniques implemented in group B combined to reduce the risk of reoperative CABG.

Conclusions: With appropriate myocardial protection techniques, the risk of reoperative CABG should be similar to that for a primary procedure.