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[Emergency coronary artery bypass grafting for severe ischemia in patients with left main trunk disease]
1Department of Thoracic and Cardiovascular Surgery, Fukuoka Tokushukai Hospital, Japan.
Insights
Emergency coronary artery bypass grafting (CABG) for severe left main trunk (LMT) disease requires prompt circulatory support and catheter intervention for recanalization. These interventions are crucial for improving survival rates in high-risk patients with LMT disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Critical Care Medicine
Context:
- Severe left main trunk (LMT) disease poses a significant surgical challenge.
- Emergency coronary artery bypass grafting (CABG) is often indicated for acute LMT conditions.
- Patient demographics included a wide age range (45-87 years), with 10 over 80.
Purpose:
- To evaluate the outcomes of emergency CABG in patients with severe LMT disease.
- To assess the role of percutaneous interventions in conjunction with CABG.
- To identify key factors influencing survival in this high-risk cohort.
Summary:
- Thirty-eight patients with severe LMT disease underwent emergency CABG between 1994 and 1998.
- Indications included acute myocardial infarction (AMI) with LMT occlusion (LMT-AMI), unstable angina (LMT-UAP), AMI with LMT stenosis, and chronic LMT occlusion with heart failure.
- Percutaneous cardiopulmonary support and intra-aortic balloon pump (IABP) were utilized in critical cases, with LMT recanalization preceding CABG.
Impact:
- Operative mortality varied by indication: 28.6% for LMT-AMI, 20% for AMI with LMT, 0% for LMT-UAP, and 50% for LMT-OMI.
- Five of seven LMT-AMI patients survived left main shock syndrome.
- Rapid circulatory support and LMT recanalization via catheter intervention are vital for successful outcomes in emergency LMT disease management.
Abstract:
Between Jan. 1994 and Feb. 1998, thirty-eight patients underwent emergency coronary artery bypass grafting (CABG) for severe left main trunk (LMT) disease. The age ranged from 45 to 87 (mean 69.8), including 10 patients over 80 years. Surgical indications were: acute myocardial infarct (AMI) due to acute occlusion of LMT (LMT-AMI) in 7, unstable angina with severe LMT stenosis (LMT-UAP) in 19, AMI due to branch occlusion with severe LMT stenosis (AMI with LMT) in 10, and chronic LMT occlusion with ongoing congestive heart failure (LMT-OMI) in 2 patients. Five of the 7 patients with LMT-AMI were successfully resuscitated from ventricular fibrillation at the emergency room in 2 (cardio-pulmonary arrest on arrival), and at the cathe-room in 3 patients. For these patients, percutaneous cardiopulmonary support system + intra aortic balloon pump (IABP) were required in 3, and IABP in 2 patients before or during catheter intervention. LMT was then recanalized by catheter intervention prior to CABG. Operative mortality were 28.6% (2/7) in LMT-AMI, 20% (2/10) in AMI with LMT, 0% (0/19) in LMT-UAP, and 50% (1/2) in LMT-OMI. Five of the 7 patients with LMT-AMI, survived the most hazardous condition of left main shock syndrome. Quick establishment of the circulatory support and recanalization of LMT by catheter intervention prior to CABG are the key factors for saving their lives.