Related Experiment Videos
[Emergency and subemergency coronary artery bypass graft: active use of arterial grafts]
1Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Insights
Emergency and subemergency coronary artery bypass grafting (CABG) using arterial grafts, even with intra-aortic balloon pumping (IABP), can improve patient outcomes. Arterial grafts demonstrated high patency rates in both groups, suggesting their suitability for critical cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Context:
- This study evaluated 59 patients undergoing emergency or subemergency coronary artery bypass grafting (CABG) between June 1996 and February 1999.
- Patients were stratified into two groups: emergency (operated within 24 hours) and subemergency (operated after 24 hours).
- The emergency group included patients requiring interventions like cardiac resuscitation and intra-aortic balloon pumping (IABP) preoperatively.
Purpose:
- To assess the feasibility and outcomes of using arterial grafts in emergency and subemergency coronary artery bypass grafting (CABG).
- To compare graft patency rates and operative results between conventional CABG and minimally invasive direct coronary artery bypass grafting (MIDCAB).
Summary:
- In the emergency group (13 patients), 52% utilized arterial grafts, with all arterial grafts patent postoperatively. One operative and one hospital death occurred.
- The subemergency group (46 patients) showed high arterial graft utilization (84.7%), with 96% patency for arterial grafts. One late death due to mediastinitis was reported.
- Both conventional CABG and MIDCAB approaches were employed, with arterial grafts showing excellent patency in both emergency and subemergency settings, even with IABP support.
Impact:
- Coronary artery bypass grafting (CABG) using arterial grafts is viable and safe, even in critically ill patients requiring intra-aortic balloon pumping (IABP).
- The study highlights the potential for improved late prognosis through the consistent use of arterial conduits in urgent cardiac revascularization procedures.
- Findings support the expanded use of arterial grafts in both standard and minimally invasive CABG techniques for better long-term graft performance.
Abstract:
Fifty-nine patients underwent emergency or subemergency coronary artery bypass grafting (CABG) from June 1996 to February 1999. The patients were divided into two groups, namely an emergency group (13 patients) and subemergency group. The patients in the emergency group were operated on within 24 hours of diagnosis and those in the subemergency group were operated immediately after 24 hours of diagnosis. In the emergency group, two patients required cardiac resuscitation before operation because of a cardiogenic shock. Eleven patients of the emergency group required intra-aortic balloon pumping (IABP) before operation. Eleven patients operated for mediansternotomy with a cardiopulmonary bypass and remaining two patients for minimally invasive direct coronary artery bypass grafting (MIDCAB). The ratio of arterial grafts was 52% in the emergency group (8 LITA, 7 Radial artery, 1 RGEA). Four of the 13 patients used only SVG. There was one each of the operative and hospital death. On the post operative angiography of the grafts, arterial graft were all patent. In the subemergency group, 38 of 46 patients underwent conventional CABG with median sternotomy using a cardiopulmonary bypass. MIDCAB was indicated in eight patients. Thirty-one patients had a bypass formed with only arterial grafts, 84.7% of whom used arterial grafts. On the postoperative angiography, LITA, RGEA, and IEA were all patent and the radial artery was occluded in one anastmosis (96%). Only one patients died of mediastinitis 25 days after operation. In both groups CABG using arterial grafts can be done even with IABP inserted if the preoperative condition is stable. This will help improve late prognosis.