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[Coronary bypass grafting after failed percutaneous angioplasty (PTCA)]
B Kapelak1, J Sadowski, R Pfitzner
1Kliniki Chirurgii Serca i Naczyń, Uniwersytetu Jagiellońskiego w Krakowie.
Insights
Emergency coronary artery bypass grafting (CABG) after failed percutaneous transluminal coronary angioplasty (PTCA) is associated with significant risks. These emergency procedures carry a higher risk of mortality and serious complications.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for acute myocardial ischemia.
- Failed PTCA can necessitate emergency surgical intervention.
Purpose of the Study:
- To evaluate the outcomes of emergency coronary artery bypass grafting (CABG) following failed PTCA.
Main Methods:
- Retrospective analysis of 23 patients undergoing emergency CABG after failed PTCA between 1991 and 1997.
- Data collected on patient demographics, procedural details, complications, and outcomes.
Main Results:
- 1.2% of 1883 PTCAs required emergency CABG.
- The most frequent complication was myocardial infarction (52%), followed by low output syndrome (42%).
- Mortality rate was 4.3% with a mean hospitalization of 11 days.
Conclusions:
- Emergency CABG after failed PTCA presents a high risk of mortality and postoperative complications.
- Careful patient selection and management are crucial for these high-risk procedures.
Abstract:
Between January 1991 and September 1997, in the Cardiovascular Surgery Department of the Institute of Cardiology of Jagiellonian University Medical School, 23 patients underwent emergency CABG due to acute myocardial ischaemia in result of failed PTCA. Over the same period of time invasive cardiologists performed 1883 PTCAs out of which 23 (1.2%) were emergency cardiosurgical procedures, and in 38 patients, stents were implanted in the damaged coronary arteries. The patients' age ranged from 37 to 67 years (median 52.2). In all patients good left ventricular function was preserved, median ejection fraction being 64%. Two patients required IABP to support left ventricular function. 1-4 bypass grafts were implanted (median 1.9 per patient). In one patient, internal mammary artery was collected and then implanted into anterior interventricular branch. The most common complication was myocardial infarction which occurred in 12 patients (52%). In ten patients low output was observed postoperatively. One operated patient (a female died (4.3%). The mean time of hospitalization was 11 days. Emergency myocardial revascularisation procedures performed after failed PTCA, bring higher risk of mortality and dangerous postoperative complications.