Evaluation of the Risk Factors Affecting Hospital Mortality in Coronary Artery Bypass Reoperations

Objective: In our study, we aimed to investigate the risk factors for hospital mortality in reoperative coronary bypass surgery. Material and Methods: In our clinic, 105 (mean age 58.6±8.8 years, age range 19-79) patients who underwent isolated reoperative coronary artery bypass grafting between 1998 and 2010 were examined using a retrospective cohort study design. Patients who had concomitant procedures were excluded from the study. The risk factors that caused hospital mortality were investigated by using the preoperative, operative and postoperative variables. Independent risk factors for hospital mortality were determined by logistic regression analysis. Results: Hospital mortality was found as 12.3% (13 patients). Thirty-seven percent of patients were operated on between 1998 and 2004, and 62.9% between 2005 and 2010. The average time between two operations was 7.80 ± 5.38 years, ranged between 1 and 20 years. Univariate analysis of risk factors for hospital mortality were found as not using the internal mammary artery in the first operation, incomplete revascularization, Canadian Cardiovascular Society class 3 or 4 pain, advanced left ventricular dysfunction, low cardiac output, 10 years or more between two operations, prolonged intubation and revision due to bleeding or graft occlusion. Logistic regression analysis of independent risk factors for hospital mortality after reoperative coronary bypass surgery were found as the time between two operations 10 years or more, low cardiac output and prolonged intubation. Conclusion: Determining the risk profile and patient selection may be the first step in order to reduce hospital mortality. In patients with high-risk profile, alternative treatment modalities such as hybrid revascularization, with off-pump technique or optimal medical treatment may be considered.