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[Complete arterial revascularization in emergency CABG]
H Nishida1, Y Tomizawa, M Endo
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Insights
Emergency coronary artery bypass grafting (CABG) using only arterial grafts shows excellent long-term results for patients with multivessel or left main disease. This approach offers high patency rates and survival, suggesting it as a primary treatment option.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Context:
- Emergency coronary artery bypass grafting (CABG) is a critical intervention for acute cardiac events.
- The use of arterial conduits in CABG is associated with improved long-term patency compared to venous grafts.
- Optimizing surgical strategies for emergency CABG in patients with complex coronary artery disease is essential.
Purpose:
- To evaluate the efficacy and long-term outcomes of emergency CABG utilizing exclusively arterial conduits in patients with multivessel or left main coronary artery disease.
- To assess graft patency, survival rates, and cardiac event-free survival in this patient cohort.
Summary:
- A study of 37 patients undergoing emergency CABG with arterial grafts between 1987 and 1998 demonstrated excellent outcomes.
- The procedure involved a mean of 2.65 anastomoses, with high graft patency rates (overall 90.6%).
- Five-year actuarial survival was 97.1%, and the cardiac event-free rate was 75.7%, with one early death from heart failure.
Impact:
- Complete arterial grafting in emergency CABG is a viable and effective strategy for selected patients with severe coronary artery disease.
- These findings support the consideration of arterial grafts as a primary treatment in emergency CABG settings, particularly for multivessel or left main disease.
- The study highlights the potential for excellent long-term graft function and patient survival, reducing the need for repeat interventions.
Abstract:
Between August 1987 and November 1998, 137 patients underwent emergency CABG within 24 hours from the notification of cardiologist. Among them, 37 patients (27%) (34 men, 3 women) with a mean age of 59.9 (range, 39-76) underwent multiple CABG with exclusive use of arterial conduits. Preoperative diagnosis was acute myocardial infarction in 20 patients and unstable angina in 17 patients. Twenty-nine patients (78%) had either triple vessel or left main disease. There were 3 redo CABG and 3 patients were on hemodialysis. Postoperative follow-up averaged 44 months. Twenty-nine patients (78%) were under IABP support preoperatively. The mean number of anastomoses was 2.65 (range, 2-5). One patient (2.7%) died of persistent heart failure 54 days postoperatively. The patency was confirmed angiographically in 33 patients 3-4 weeks after surgery. Overall patency was 90.6% (LITA: 93.0%, RGEA: 76.2%, RITA, radial: 100%). There were no late deaths or redo CABG, and 2 patients sustained myocardial infarction and 3 patients underwent PTCA during follow-up. Five-year actuarial survival rate was 97.1% and cardiac event-free rate was 75.7%. These excellent early and long-term results suggest that complete arterial grafting for emergency CABG should be considered as a primary treatment in patients who have multivessel or left main disease, and no ongoing profound cardiogenic shock or rapid deterioration.