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[Invasive treatment of ischemic events after coronary artery bypass grafting]
1Department of Thoracic Surgery, Japanese Red Cross, Nagoya First Hospital.
Insights
Percutaneous coronary intervention (PCI) and re-coronary artery bypass grafting (reCABG) effectively treat ischemic events post-coronary artery bypass grafting (CABG). Internal thoracic artery grafts show superior patency, reducing reCABG needs.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Context:
- Coronary artery bypass grafting (CABG) is a common treatment for coronary artery disease.
- Ischemic events can occur after CABG, necessitating further intervention.
- Internal thoracic artery (ITA) grafts demonstrate superior long-term patency compared to saphenous vein grafts (SVG).
Purpose:
- To evaluate the efficacy of percutaneous coronary intervention (PCI) and re-coronary artery bypass grafting (reCABG) for managing ischemic events following initial CABG.
- To assess the impact of graft type, specifically ITA, on the need for reintervention.
Summary:
- Thirty-two patients underwent PCI or reCABG for ischemic events post-CABG.
- PCI achieved an 88% success rate for 32 lesions, with a 36% restenosis rate.
- ReCABG utilized arterial conduits (ITA, gastro-epiploic artery) due to poor SVG patency, with ITA grafts showing better long-term patency.
Impact:
- The use of ITA grafts in initial CABG reduces the likelihood of requiring reCABG.
- Arterial conduits are recommended for reCABG due to the limited long-term patency of SVG.
- Early coronary angiography is crucial for timely diagnosis and intervention.
Abstract:
PTCA or reCABG was performed for ischemic events after CABG in 32 patients. Since 6 patients were operated on initially elsewhere, the incidence of reCABG among our own patients was 1.2% and that of PTCA was 4.5%. Only one patient of 15 patients, in whom internal thoracic artery (ITA) was utilized at the initial CABG, underwent reCABG and the other patients were treated by PTCA. The use of ITA reduced the necessity for re-CABG because of the superior long-term patency of ITA. PTCA was performed for 32 lesions (19 in saphenous vein grafts (SVG), 4 in ITA grafts, and 9 in native coronary arteries) of 23 patients with success rate of 88%. The rate of restenosis was 36%. There were no complications following PTCA. No patients were referred for emergent surgery. Intracoronary thrombolysis and PTCA for total occlusion of SVG were performed successfully if they were done early after the occurrence of ischemic events. Coronary angiography should be performed as soon as possible. Ten patients underwent re-CABG utilizing ITA in 9 patients and gastro-epiploic artery (GEA) in 3. One patient died of arrhythmia due to spasm. The other 9 patients were discharged and class I or II of NYHA functional classification. The coronary angiography, which was performed at the late follow-up period, showed occlusion of SVG and patency of ITA. The arterial conduits should be applied for reCABG because of the low long-term patency of SVG.