Redo coronary surgery with and without cardiopulmonary bypass

Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality compared to primary operation. Myocardial protection is one of the key issues in redo on pump CABG. Off pump redo CABG seems to be an alternative as morbidity which is associated with cardiopulmonary bypass (CPB) is avoided. The aim of this retrospective study was to compare the outcome of redo CABG with and without cardiopulmonary bypass. From 1/98-5/2004 redo-CABG was performed in 195 patients (pts): 162 male (83.1%) and 33 female (16.9%) pts, age 66 +/- 9 years. In 160 pts, CPB with isolated antegrade myocardial protection was used for redo CABG. Two different cardioplegic solutions were applied: HTK solution (n=128; 65.6%) and blood cardioplegic solution (n=32; 16.4%). Off pump redo CABG was performed in 35 pts (30 male (85.7%) and 5 female (14.3%) pts, age 67 +/- 8 years). Demographic, pre-, intra- and postoperative data and a follow-up of all pts were recorded. Perioperative overall mortality rate was 3.6% (n=7) and comparable in both groups (on pump 3.8% vs off pump 2.9%), as well as perioperative myocardial infarction, IABP implantation rate and secondary morbidity. Complete revascularization was possible in 139 pts (86.7%) after on pump CABG and in 17 pts (48.6%) of the off pump group. The average number of grafts was significantly higher in the on pump group (2.8 +/- 0.8 vs 1.6 +/- 0.6, p <0.05). The perfusion time was 65 +/- 39 min including a cross-damp time of 38.9 +/- 16 min. No conversion to ECC was necessary in the off pump group. During the complete follow-up further 20 pts (12.5%) of the on pump group died, with 5 pts (25%) dying due to cardiac reasons. In the off pump group 3 pts (8.6%) died in the follow-up, both due to non-cardiac related reasons. On pump redo CABG and off pump redo CABG can be safely performed with low mortality and morbidity. Off pump redo CABG might be limited due to incomplete revascularization.