Arterial conduits in emergency coronary artery surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• The internal thoracic artery (ITA) is the preferred graft for coronary artery bypass grafting (CABG).
• Hesitancy exists in using ITA for emergency CABG procedures.
• Saphenous vein grafts (SVGs) are commonly used alternatives.

Purpose of the Study:

• To evaluate the safety and efficacy of ITA grafts in emergency CABG.
• To compare outcomes between ITA and SVG use in emergency CABG.
• To assess the impact of prior percutaneous transluminal coronary angioplasty (PTCA) on ITA graft utilization and outcomes.

Main Methods:

• Retrospective analysis of 484 patients undergoing emergency CABG between 1986 and 1993.
• Patients were categorized into noninstrumented (no failed PTCA) and instrumented (within 24 hours of failed PTCA) groups.
• Graft types (ITA vs. SVG) and postoperative outcomes were compared between groups.

Main Results:

• ITA grafts were used in 62% of noninstrumented and 49.3% of instrumented patients.
• ITA recipients had similar postoperative complication rates (new Q waves, reexploration, infection, stroke) compared to SVG recipients.
• Patients receiving ITA grafts experienced fewer cardiac deaths (2.7% vs. 9.4%) and an event-free postoperative course.
• No significant differences in outcomes were observed between instrumented and noninstrumented patients.

Conclusions:

• The internal thoracic artery (ITA) is a viable and safe option for emergency coronary artery bypass grafting (CABG) in selected patients.
• Emergency CABG using ITA grafts is associated with reduced cardiac mortality and improved postoperative outcomes compared to SVG grafts.
• Prior percutaneous transluminal coronary angioplasty (PTCA) did not negatively impact the use or outcomes of ITA grafts in emergency CABG.