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[Should arterial grafts be used for urgent coronary artery bypass surgery?]
T Hirotani1, T Kameda, T Kumamoto
1Department of Cardiovascular Surgery, Tokyo Saiseikai Central Hospital, Japan.
Insights
Arterial grafts can be safely used in urgent coronary artery bypass grafting (CABG), offering better long-term outcomes compared to vein grafts alone. This approach does not adversely affect operative results.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Context:
- Urgent coronary artery bypass grafting (CABG) presents challenges regarding arterial graft availability and immediate function.
- The efficacy and safety of using arterial grafts in urgent CABG procedures remain unclear.
Purpose:
- To evaluate whether the utilization of arterial grafts in urgent CABG impacts patient outcomes negatively.
- To compare the long-term results of arterial grafts versus saphenous vein grafts in urgent CABG.
Summary:
- A review of 20 consecutive patients undergoing urgent CABG identified 11 who received at least one arterial graft.
- The hospital mortality rate was 5.0% (1 death).
- Patients receiving arterial grafts demonstrated superior overall survival, cardiac-death-free rates, and cardiac-event-free rates compared to those with only saphenous vein grafts.
Impact:
- Arterial grafts are suggested for use in urgent CABG, as they do not appear to worsen operative results.
- Employing arterial grafts in urgent CABG may lead to improved long-term patient benefits and survival.
Abstract:
It is not clear whether arterial grafts should be used for emergency or urgent coronary artery bypass grafting (CABG) because harvest of internal thoracic arteries (ITAs) is not easy under urgent conditions and the blood flow through the ITAs may be inadequate immediately after CABG. The purpose of this study was to assess whether the use of arterial grafts in urgent CABG affects the outcome adversely or not. Twenty consecutive patients who underwent urgent CABG within 48 hours following coronary angiography at our institute between July 1991 and October 1998 were reviewed. The patients who underwent CABG with associated procedures were excluded. Among these subjects, 11 patients received at least one arterial graft. Only 1 patient died of subarachnoidal hemorrhage, and the hospital mortality rate was 5.0%. According to the overall survival rate, cardiac-death-free rate, and cardiac-event-free rate, the long-term outcome was much better in the patients with arterial grafts than those with saphenous vein grafts alone. We suggest that arterial grafts should be used even for urgent CABGs since the use of arterial grafts may not affect operative results adversely and will confer better long-term benefits.