Reoperation for myocardial revascularization

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We have reported our experience with 50 patients who underwent reoperation. These 50 reoperations were necessary, because of an inadequate first operation in 26% of the cases, occlusion or stenosis of the previous grafts in 46%, and progression of the atherosclerotic process in the native coronary vessels in 6%. The additional 20% were judged as having both occluded grafts as well as an inadequate operation at the first procedure. In our early experience of the 1960s, we performed some Vineberg operations which we now judge as completely inadequate, and these provided some of these cases. From 1969 through 1972, we went through a period of providing only one or two vein grafts even though nearly all the patients had three-vessel disease. Therefore, we left large areas of left ventricular myocardium supplied by obstructed coronary vessels. Almost all these patients had clinical relief of angina, but for the patients requiring a second operation this relief lasted only a few months. In our series, 40% were reoperated on within 1 year and two thirds within 2 years of the First operation.

Now we attempt to revascularize the myocardium completely by placing at least one graft to Spring 1978 each area supplied by an occluded or stenotic coronary vessel. Most patients have four or five coronary anastomoses at the first procedure.

Since this report, additional patients have undergone reoperation and only one could be judged as having had an inadequate first operation. He had two grafts at the first operation, and a moderately . . .



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