Related Experiment Videos
[Prevention of coronary spasm during and shortly after coronary revascularization in patients with variant angina]
S Watanabe1, K Hayashi, H Yamanishi
1Department of Cardiovascular Surgery, Hokko Cardiovascular Hospital, Sapporo, Japan.
Insights
This study found that intensive preventive measures significantly reduced perioperative myocardial infarction in patients undergoing coronary artery bypass grafting (CABG) with coronary spasm. The new protocol effectively managed coronary spasm, preventing complications like myocardial infarction.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Pharmacology
Context:
- Perioperative coronary spasm is a significant complication during coronary artery bypass grafting (CABG).
- Previous protocols using diltiazem and nitroglycerin showed high rates of perioperative myocardial infarction (PMI).
Purpose:
- To evaluate the effectiveness of an intensive preventive and suppressive protocol for perioperative coronary spasm in CABG patients.
- To reduce the incidence of PMI and operative mortality in high-risk patients.
Summary:
- A new protocol involving ergometrine testing, intra-aortic balloon pumping, Valsalva sinus catheterization with isosorbide dinitrate, and nasogastric nifedipine was implemented.
- This intensive approach successfully managed coronary spasm in 5 patients (Group 2), resulting in no PMI or operative deaths.
- Compared to the previous protocol (Group 1), the new protocol showed a statistically significant reduction in PMI (p < 0.05).
Impact:
- The findings demonstrate that combined intensive preventive/suppressive measures are effective in managing perioperative coronary spasm during CABG.
- This improved protocol can significantly decrease the risk of perioperative myocardial infarction in patients with variant angina undergoing CABG.
Abstract:
From June 1990 to March 1993, 9 patients undergoing coronary artery bypass grafting (CABG), 4.4% of all CABG cases at our hospital during this period, had significant perioperative coronary spasm. For 4 patients who underwent CABG before May 1992 (Group 1), preventive and suppressive procedures for the coronary spasm were the addition of diltiazem in the cardioplegic solution and the continuous intravenous infusion of nitroglycerin. Perioperative myocardial infarction (PMI) occurred in all 4 patients in Group 1, with the mean peak MB-CPK of 356 +/- 197 IU/l. One patient had delayed sternal closure because of his unstable hemodynamic status. Thereafter, we changed our protocol as follows: 1) Ergometrine loading (intracoronary infusion) test was performed in all candidates for CABG, aiming at finding out patients with a high risk. And for the high-risk patients, in addition to the measures done in Group 1, 2) intraaortic balloon pumping was performed through the perioperative period, and 3) a pig-tail catheter was dwelled in the Valsalva sinus, through which bolus doses of isosorbide dinitrate were injected frequently in this period. 4) Additionally nifedipine was periodically administered through the nasogastric tube. With these intensive preventive/suppressive measures, the perioperative spasm in 5 patients (Group 2) with variant angina were successfully managed, with no resultant PMI nor operative death (The occurrence of PMI was significantly less frequent in Group 2 than in Group 1, with the p value < 0.05). For patients with variant angina undergoing CABG, combined intensive preventive/suppressive measures for perioperative coronary spasm as listed above proved effective.