IN ISCHAEMIC HEART DISEASE -OUR EXPERIANCES
S. Nastasić, R. Huskić, Z. Jocić, B. Đukanović, D. Nežić,
S. Gradinac, A. Nikolić, M. Jakovljević, P. Milojević, M.
Perić, S. Birovljev and M. Babić
Cardiovascular Institute, Belgrade, Yugoslavia.
Aim: Analysis of 242 patients with REDO
Aortocoronary bypass procedure (REDO ACB), who had been operated
at Dedinje Cardiovascular Institute, Belgrade from January 1995
to August 31. 2000. The most important conditions for successful
reoperation in ischaemic heart disease (IHD) are viability of
myocardium and acceptable pathologic morphology on coronary arteries,
which are still anatomically convenient for bypass procedure.
In our 242 patients interval between the first ACB and REDO-ACB
was 8,3 years. Most frequent reasons for REDO were evolution of
occlusive changes on native coronary arteries and grafts, while
pathologic changes on heart valves and aortic dissection were
less frequent causes for REDO-ACB. Mutual finding in vast majority
of almost every single patient was significantly higher ejection
fraction (EF) in time of first ACB than REDO ACB. Operative technique
was extracorporal circulation (ECC), only in 5 cases we operated
patients on beating heart, while 3 operations were performed ion
deep hypothermic circulatory arrest. Operative risk- mortality
in REDO-ACB during 1995-1996 was 7,9%. As the number of REDO-ACB
increased and our experience widened, we significantly decreased
mortality rate to 4,4% in 1999 through 2000.
Conclusion: Operative risk in REDO-ACB in our experience
is not considerably higher than in first ACB procedure, and we
believe that with good selection, indications, experience, myocardial
protection and operative technique these results may be further