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[Emergency coronary bypass surgery after failed coronary angioplasty]
Insights
Emergency coronary artery bypass grafting (CABG) after percutaneous transluminal coronary angioplasty (PTCA) failure occurred in 0.68% of patients. Prompt CABG may reduce acute myocardial infarction and death in PTCA failures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Context:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Angioplasty failure necessitates further intervention, often emergency coronary artery bypass grafting (CABG).
Purpose:
- To determine the incidence and outcomes of emergency CABG following PTCA failure.
- To analyze indications for emergency CABG and associated morbidity and mortality.
Summary:
- Of 1,315 patients undergoing PTCA, 9 (0.68%) required emergency CABG due to angioplasty failure.
- Indications included dissection, acute occlusion with myocardial infarction (MI), cardiogenic shock, and cardiac arrest.
- Emergency CABG had an 11% mortality rate, with increased risk in hemodynamically unstable patients.
Impact:
- Prompt emergency CABG after PTCA failure may decrease the incidence of acute MI and death.
- Understanding these outcomes is crucial for managing complex cardiovascular interventions.
Abstract:
Of 1,315 consecutive patients undergoing PTCA, 9 eventually underwent emergency CABG because of angioplasty failure (emergency rate 0.68%). The indication for emergency bypass was dissection with threatening occlusion in 3 patients, acute occlusion with evolving MI in 3 patients, cardiogenic shock in 1 patient, intractable cardiac arrest in 2 patients. Eight patients were taken directly to the operating room from the catheterization laboratory. The overall mortality of emergency CABG was 11%. One of the two patients with cardiac arrest died of LOS postoperatively. Two patients developed perioperative myocardial infarction (25%). The incidence of operative morbidity and mortality were significantly increased among patients with hemodynamic instability. Should PTCA failure become evident, the prompt undertaking of emergency CABG could perhaps decrease the incidence of acute MI and death.