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[Invasive treatment in patients with prior coronary artery bypass grafting]
Insights
For patients with prior coronary artery bypass grafting (CABG), invasive treatments like percutaneous transluminal coronary angioplasty (PTCA) offer safe and effective options for recurrent cardiac symptoms. These procedures demonstrate good success rates, improving outcomes for carefully selected individuals.
Area of Science:
- Cardiology
- Interventional Cardiology
Context:
- Patients with prior coronary artery bypass grafting (CABG) often experience recurrent cardiac symptoms.
- Late follow-up reveals symptom recurrence in a significant portion of patients post-CABG.
Purpose:
- To evaluate the safety and efficacy of invasive treatments, including percutaneous transluminal coronary angioplasty (PTCA) and intracoronary thrombolysis (ICT), in patients with prior CABG and recurrent symptoms.
Summary:
- Out of 883 patients with prior CABG, 179 experienced recurrent symptoms. PTCA was performed in 43 patients with a 68% success rate in venous grafts and 74% in native arteries. Intracoronary thrombolysis (ICT) had a 67% success rate per occlusion. Reoperations were performed in 20 patients with low mortality.
- No emergency CABG was required after failed PTCA, indicating procedural safety.
Impact:
- Invasive treatments are safe and effective for selected patients with prior CABG and disabling symptoms.
- These procedures should be considered when suitable lesions are identified in native coronary arteries or vein grafts, offering a viable alternative to repeat bypass surgery.
Abstract:
In eight hundred eighty three patients with prior coronary bypass grafting (CABG), cardiac symptoms were recurred in 179 patients in late follow-up period (mean 5 +/- 2.8 years). Of 179 patients, 43 patients had PTCA eventually. In these, 57 times of angioplasties were attempted. Twenty-one lesions in venous bypass grafts and 50 in native coronary arteries were performed, respectively. The initial success rate per bypass graft and per stenosis of native coronary artery were 68% and 74%, respectively. Five patients had elective CABG following failed PTCA. There were no emergency CABG procedures required after unsuccessful PTCA. Intracoronary thrombolysis (ICT) were performed in 13 patients. In these, 15 ICT attempts were made. Nine lesions in venous bypass grafts, 9 for native coronary arteries, and 3 for both were attempted. The primary success rate per occlusion was 67%. Twenty reoperation were done. There was one hospital death and one late death due to congestive heart failure 4 years after the reoperation. In conclusion, invasive treatments in patients with prior CABG can be performed with satisfactory safety and good results. Therefore, invasive treatment should be considered in the patients with CABG if cardiac symptoms are disabling and angiographically suitable lesions are present in the native coronary arteries or vein grafts.