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Thirty-five consecutive patients undergoing a third-time coronary revascularisation between 1982 and 1992 were retrospectively reviewed. These patients represented 6% (35/579) of coronary reoperations and 0.5% (35/6772) of total coronary bypass operations in the unit during that period. The indication for operation was recurrent or intractable angina due to total or partial graft failure. The mean number of grafts per patient was 2.7 (range, 1 to 5). Arterial grafts, new internal mammary arteries and inferior epigastric artery were placed in 22 patients (63%). All patients survived the early postoperative period. One patient (3%) required re-exploration for bleeding, three (9%) required intra-aortic balloon pump support, and nine (26%) had temporary postoperative atrial fibrillation. Follow-up data for 10 to 138 months (mean, 31 months) revealed a 5-year survival of 91%. Of 32 late survivors, 18 patients (57%) were free of angina. Among 14 patients (44 %) who had recurrent angina, only 1 patient (3%) had Class IV angina compared with 34% Class IV angina patients preoperatively. Third-time coronary revascularisation can be performed with good early and late clinical results.
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