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[Emergency bypass operation after failed elective percutaneous transluminal coronary angioplasty]
B Schumacher1, P Pecher, M Keilich
1Klinik für Thorax-, Herz- und Gefässchirurgie, Klinikum Fulda.
Insights
Failed percutaneous coronary angioplasty (PTCA) often requires coronary artery bypass graft (CABG) surgery. Shorter ischemic intervals during emergency CABG after failed PTCA correlate with lower cardiac enzyme levels and better outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Percutaneous coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Failed PTCA can necessitate urgent or elective coronary artery bypass graft (CABG) surgery.
- Understanding complications and outcomes after failed PTCA is crucial for patient management.
Purpose of the Study:
- To evaluate clinical and angiographic characteristics of patients undergoing CABG after failed PTCA.
- To assess in-hospital complications associated with failed PTCA requiring subsequent CABG.
- To compare outcomes between emergency and elective CABG following PTCA failure.
Main Methods:
- Retrospective study of 123 patients who underwent CABG after failed PTCA between January 1990 and December 1992.
- Analysis of patient demographics, procedural details, angiographic findings, and surgical outcomes.
- Comparison of outcomes based on timing of CABG (emergency, 24-hour, or elective).
Main Results:
- Failed PTCA leading to CABG occurred in 123 patients, with acute vessel occlusion/dissection being a common cause (36.5%).
- Emergency CABG (35% of patients) was often due to hemodynamic instability; 93% had acute dissection.
- Elective CABG (49.5%) was performed significantly later (3.8 months). Shorter ischemic intervals (≤70 min) were associated with lower postoperative CK and CK-MB levels.
Conclusions:
- Failed PTCA necessitating CABG presents with varied clinical scenarios and requires careful surgical planning.
- Emergency CABG after failed PTCA is associated with higher myocardial injury markers, emphasizing the importance of minimizing ischemic time.
- The use of internal mammarian artery grafts was higher in the elective group, suggesting different surgical strategies based on urgency.
Abstract:
This retrospective study was performed to evaluate the clinical and angiographic characteristics and the in-hospital complications after failed percutaneous coronary angioplasty (PTCA) that necessitates coronary artery bypass graft surgery (CABG). The study population consisted of 123 patients from January 1990 to December 1992. The failed PTCA was secondary to an acute occlusion of the dilated but dissected vessel in 36.5% of the study population. 43 patients (35%) had an emergency CABG due to hemodynamic instability and a large area of myocardium at risk for infarction. 93% of these patients had an acute closure of the dissected vessel. 19 patients (15%) were operated 24 hours after failed PTCA and 61 patients (49.5%) electively 3.8 +/- 1.1 months after PTCA. Mean time interval from the acute occlusion up to the establishment of the extracorporeal circulation (ischemic interval) was 70 +/- 9 min. in patients from our cardiological department and 136 +/- 14 min. in patients from external departments. Analysis of the surgical data revealed that neither a patient of the emergency group nor of the elective group needed the intra-aortic balloon pump. Overall 2.3 +/- 0.8 bypass grafts were placed, with increased use of the internal mammarian artery in the elective (57%) versus the emergency group (17%). Postoperative peak values of CK and CK-MB were significantly higher in the emergency group as compared to the patients operated 24 hours and electively after failed PTCA. Patients with an ischemic interval up to 70 min. had considerably lower CK and CK-MB values compared to patients with longer ischemic intervals.(ABSTRACT TRUNCATED AT 250 WORDS)