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Emergency coronary artery bypass surgery after failed percutaneous transluminal coronary angioplasty
J J Andreasen1, P E Mortensen, L I Andersen
1Department of Cardiothoracic Surgery, Aalborg Hospital, Denmark. jjandreasen@dadlnet.dk
Insights
Emergency coronary artery bypass grafting (CABG) after percutaneous transluminal coronary angioplasty (PTCA) complications resulted in a 12% in-hospital mortality. Early surgery within 6 hours showed inferior outcomes compared to elective procedures, highlighting the need for immediate cardiothoracic support.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) can lead to complications requiring emergency coronary artery bypass grafting (CABG).
- A significant percentage of PTCA patients necessitate urgent CABG, impacting patient outcomes.
Purpose of the Study:
- To evaluate the outcomes of emergency CABG performed within 6 hours following PTCA complications.
- To identify risk factors and complications associated with emergency CABG after PTCA.
Main Methods:
- Retrospective review of 86 patients undergoing emergency CABG within 6 hours of PTCA complications.
- Analysis of patient demographics, coronary artery disease extent, surgical procedures, and in-hospital outcomes.
Main Results:
- 51% of patients experienced perioperative Q-wave myocardial infarction.
- In-hospital mortality rate was 12%, with inferior results compared to elective CABG.
- The right coronary artery and left anterior descending branch (LAD) were most frequently injured.
Conclusions:
- Emergency CABG following PTCA complications is associated with high rates of myocardial infarction and mortality.
- Immediate cardiothoracic surgical backup is crucial during PTCA in unselected patient populations.
Abstract:
Coronary complications caused by percutaneous transluminal coronary angioplasty (PTCA) may necessitate emergency coronary artery bypass grafting (CABG). In 1994-1998, 132 patients (1.5% of the patients registered in the Danish PTCA registry) underwent CABG within 24 h because of angioplasty complications. We reviewed the files of 86 patients who had emergency operations within 6 h and found that 35% suffered from 1-vessel disease. Fifty-eight percent were taken directly to the operating room from the cardiovascular laboratory, and 13% were given preoperative cardiovascular resuscitation. The vessels most frequently injured were the right coronary artery and the left anterior descending branch (LAD). The patients received a mean of 2.4 coronary bypasses each. Forty-three percent of the patients with lesions of the left main coronary artery and/or the LAD received a vein graft to the LAD. A perioperative Q-wave myocardial infarction developed in 51% of the patients. The in-hospital mortality rate was 12%. These results are inferior to those obtained after elective surgery. Local cardiothoracic backup is vital when PTCA is performed in an unselected patient group.