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Use of internal mammary artery for emergency grafting after failed coronary angioplasty
1Department of Cardiac Surgery, University Hospital, Ghent, Belgium.
Insights
Emergency coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty is safe, with no hospital deaths. Internal mammary artery grafts are effective, particularly in hemodynamically stable patients, showing acceptable morbidity.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) can fail, necessitating emergency coronary artery bypass grafting (CABG).
- Patient hemodynamic status significantly impacts outcomes following emergency CABG after PTCA failure.
Purpose of the Study:
- To evaluate the safety and efficacy of emergency CABG following failed PTCA.
- To compare outcomes between hemodynamically stable and unstable patients undergoing emergency CABG.
Main Methods:
- Retrospective analysis of 929 patients undergoing PTCA over 36 months.
- 32 patients required emergency CABG, divided into stable (n=22) and unstable (n=10) groups.
- Graft types, operative details, and postoperative outcomes were analyzed.
Main Results:
- No hospital deaths occurred in the emergency CABG group.
- The unstable group had shorter bypass intervals and more grafts per patient (p < 0.05).
- Internal mammary artery grafts were used in 84% of patients; myocardial infarction incidence was higher in the unstable group (p < 0.005).
Conclusions:
- Emergency CABG after failed PTCA is feasible with low mortality.
- Internal mammary artery grafts are a viable option in this setting.
- Hemodynamically stable patients experience better postoperative outcomes compared to unstable patients.
Abstract:
Of 929 consecutive patients who underwent percutaneous transluminal coronary angioplasty over a 36-month period, 32 (3.4%) had emergency coronary artery bypass grafting for angioplasty failure. Twenty-two patients (69%) were hemodynamically stable (stable group), and 10 (31%) were unstable (unstable group) before emergency bypass. In the unstable group, the interval between failed angioplasty and opening of the grafts or end of extracorporeal circulation was significantly shorter (p < 0.001 and p < 0.002, respectively) and significantly more grafts per patient were performed (p < 0.05) than in the stable group. Twenty-seven patients (84%) received at least one internal mammary artery graft, independent of their hemodynamic condition. In 11 culprit left anterior descending arteries, the internal mammary artery graft was supplemented by a saphenous vein graft to the same territory, especially in the unstable group. There were no hospital deaths. Postoperatively, the incidence of myocardial infarction (p < 0.005) and the use of antiarrhythmics (p < 0.0001) were increased and length of stay tended to be longer in the unstable compared with the stable group. The use of a reperfusion catheter had no influence on clinical outcome, except for a significantly reduced postoperative use of antiarrhythmics (p < 0.05). The internal mammary artery can be used in emergency coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty, without hospital mortality and with acceptable morbidity, especially in hemodynamically stable patients.