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Early postoperative balloon coronary angioplasty for failed coronary artery bypass grafting
J K Kahn1, B D Rutherford, D R McConahay
1Cardiovascular Consultants, Inc., Kansas City, Missouri 64111.
Insights
Percutaneous transluminal coronary angioplasty effectively treats recurrent ischemia after coronary artery bypass grafting failure. This procedure offers significant relief from anginal symptoms and improves long-term patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) may fail to alleviate anginal symptoms in a subset of patients.
- Recurrent ischemia post-CABG necessitates effective treatment strategies to prevent adverse cardiac events.
Purpose of the Study:
- To evaluate the efficacy of percutaneous transluminal coronary angioplasty (PTCA) for early recurrent ischemia following CABG.
- To identify the anatomical causes of ischemia and assess angioplasty success rates in native arteries and bypass grafts.
Main Methods:
- A cohort of 45 patients with recurrent ischemia within 90 days of CABG underwent PTCA.
- Angiographic analysis identified mechanisms of ischemia, including graft occlusion/stenosis and native vessel disease.
- PTCA success rates were assessed at native artery lesions, vein graft lesions, and internal mammary artery lesions.
Main Results:
- PTCA was successful in 93% of treated sites, including native arteries (95%), vein grafts (89%), and internal mammary arteries (100%).
- Complete revascularization was achieved in 84% of patients.
- At a mean follow-up of 44 months, 35 patients had absent or minimal angina, with 17 returning to full-time employment.
Conclusions:
- Percutaneous transluminal coronary angioplasty is a valuable treatment option for myocardial ischemia occurring after CABG.
- The procedure demonstrates high success rates and leads to significant symptomatic improvement and functional recovery in most patients.
Abstract:
In a small number of patients, coronary artery bypass grafting (CABG) fails to relieve anginal symptoms. The usefulness of coronary angioplasty for the treatment of early (less than or equal to 90 days) recurrent ischemia after CABG was examined. Forty-five patients were treated from 2 to 90 days after CABG, including 8 patients studied emergently for prolonged ischemic symptoms. One-, 2- and 3-vessel native disease was found in 4, 10 and 31 patients, respectively. At the time of postoperative angiography, the major anatomic mechanism of recurrent ischemia was complete vein graft occlusion in 12 patients (27%), internal mammary artery occlusion in 3 (7%), vein graft stenoses in 13 (29%), internal mammary artery stenoses in 10 (22%), unbypassed disease in 4 (8%) and disease distal to the graft insertion site in 3 (7%). Angioplasty was successful at 91 of 98 sites (93%), including 95% of 41 lesions in native arteries, 89% of 46 lesions in vein grafts and 100% of 11 internal mammary artery lesions attempted. Complete revascularization was achieved in 84% of patients. There were 2 in-hospital deaths and 2 myocardial infarctions. Two additional patients underwent repeat CABG before discharge after uncomplicated but unsuccessful angioplasty. At late follow-up of the 43 survivors (mean 44 months), there were 4 deaths, 2 of which were noncardiac. Repeat CABG was required in only 3 patients and repeat angioplasty was performed in 10. Angina was absent or minimal in 35 patients; 17 patients were employed full time. Thus, percutaneous transluminal coronary angioplasty can relieve myocardial ischemia after unsuccessful CABG in the majority of patients.