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Coronary angioplasty in symptomatic patients after bypass surgery
1Department of Cardiology, St. Michael's Medical Center, Newark, NJ 07102.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) offers a safe and effective alternative for managing recurrent angina after coronary artery bypass surgery (CABG). This minimally invasive procedure demonstrates high success rates with fewer complications compared to repeat surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Recurrent angina after coronary artery bypass surgery (CABG) presents a management challenge.
- The advent of percutaneous transluminal coronary angioplasty (PTCA) has introduced new therapeutic options.
Purpose of the Study:
- To evaluate the safety and efficacy of PTCA in patients experiencing recurrent angina post-CABG.
- To compare PTCA outcomes with repeat CABG and medical management in this patient cohort.
Main Methods:
- A retrospective review of 149 symptomatic post-CABG patients undergoing coronary angiography between January 1987 and December 1988.
- Patients were managed with medical therapy (90), repeat surgery (14), or PTCA (45).
- Outcomes and complications for each treatment group were analyzed.
Main Results:
- PTCA achieved high success rates: 88% in native vessels and 91.7% in vein grafts.
- Repeat CABG had significant complications, including one death and perioperative myocardial infarctions.
- PTCA resulted in minimal complications, with no reported deaths.
- At follow-up, restenosis occurred in 6 of 10 patients with recurrent symptoms; repeat PTCA was successful in 4.
Conclusions:
- PTCA is a feasible and safe alternative to repeat CABG for selected post-CABG patients with recurrent angina.
- PTCA offers a high success rate and a favorable complication profile compared to repeat surgery.
Abstract:
With the availability of percutaneous transluminal coronary angioplasty (PTCA), the management of patients who present with recurrent angina following coronary artery bypass surgery (CABG) has changed. From January 1987 to December 1988, 149 symptomatic post CABG patients underwent coronary angiography at our institution. Ninety were treated with medical antianginal therapy, 14 had repeat surgery, and 45 underwent PTCA. Complications of repeat CABG included one death, two perioperative myocardial infarctions, and four patients with postoperative supraventricular arrhythmia. PTCA was performed on 42 lesions in 37 native vessels (88% success rate), and on 24 lesions in 23 vein grafts (91.7% success rate). Complications included acute reocclusion (one patient), peripheral artery occlusion (one patient), hematoma formation (one patient), and periprocedure myocardial infarction (one patient). No deaths occurred. At a mean follow-up of 5.9 +/- 3.8 months, 10 patients had recurrent symptoms, six of whom were found to have restenosis. Repeat PTCA was successfully accomplished in four patients; the other two were treated medically. It is concluded that PTCA is a feasible alternative to repeat CABG in selected patients and can be achieved with a high success rate and minimal complications.