Reoperation for coronary artery disease

Appropriate operative techniques are crucial to ensure safety and achieve satisfactory outcome for the increasing number of reoperations for coronary disease. Recent emphasis has been placed on the key role of atherosclerotic vein grafts in causing operative complications. Minimal handling of patent vein conduits and retrograde cardioplegia are advocated. Use of the internal mammary artery at initial operation has been shown to both reduce the need for reoperation and to increase its safety when progression of disease makes further surgery necessary.