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Perioperative myocardial infarction caused by atheroembolism
The Journal of Thoracic and Cardiovascular Surgery
|December 1, 1982
Summary
Fatal myocardial infarction after coronary artery bypass grafting (CABG) can result from atheromatous embolization. Repeat CABG procedures carry a tenfold higher risk of this complication, necessitating preventative measures.
Area of Science:
- Cardiovascular Surgery
- Pathology
Background:
- Coronary artery bypass grafting (CABG) is a common procedure.
- Perioperative myocardial infarction is a known complication of CABG.
Purpose of the Study:
- To describe a previously unrecognized cause of perioperative myocardial infarction following CABG.
- To quantify the incidence and risk factors associated with this complication.
Main Methods:
- Retrospective analysis of 4,095 initial and 175 repeat CABG procedures.
- Histological examination of myocardial tissue and identification of atheromatous emboli.
- Review of pre-operative angiograms for patients undergoing repeat CABG.
Main Results:
- Thirteen cases of fatal perioperative myocardial infarction were linked to intraoperative atheromatous embolization.
- The risk of embolization was 0.22% during initial CABG and 2.29% during repeat CABG.
- Emboli originated from aortic root lesions, coronary endarterectomy sites, or disruption of atherosclerotic plaques in grafts.
Conclusions:
- Atheromatous embolization is a significant cause of perioperative myocardial infarction, particularly during repeat CABG.
- Identifying patients with severe graft atherosclerosis via angiography can mitigate risk.
- Ligating old vein grafts during repeat CABG is recommended to prevent atheroembolism.