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[Urgent coronary artery bypass surgery by only arterial graft for acute myocardial infarction]
S Hayashi1, M Sasaki, J Kawamoto
1Department of Cardiovascular Surgery, Chugoku Rosai Hospital, Kure, Japan.
Insights
Urgent coronary artery bypass grafting (CABG) using only arterial grafts proved safe and effective for mild to moderate acute myocardial infarction (AMI). All patients experienced favorable outcomes, demonstrating the viability of this surgical approach.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Myocardial Infarction Research
Context:
- Urgent coronary artery bypass grafting (CABG) is often performed for acute myocardial infarction (AMI).
- Traditionally, saphenous vein grafts are used in emergency CABG for optimal flow.
- The use of arterial grafts exclusively in mild to moderate AMI requiring urgent intervention was explored.
Purpose:
- To evaluate the safety and efficacy of performing urgent CABG using exclusively arterial grafts in patients with mild to moderate acute myocardial infarction (AMI).
- To assess graft patency and patient prognosis following arterial-only grafting in this specific patient cohort.
Summary:
- Nine patients with mild to moderate AMI underwent urgent CABG using only arterial grafts (RITA, LITA, RGEA).
- Patients presented within 2-24 hours of AMI onset, with CPK-MB levels ranging from 14-184 IU/l.
- Postoperative angiography confirmed all grafts were patent, with two LITA grafts showing a "string sign"; 3 patients required temporary intra-aortic balloon pumping (IABP).
Impact:
- This study demonstrates that urgent CABG using only arterial grafts can be performed safely and effectively in selected patients with mild to moderate AMI.
- Favorable short-term outcomes suggest arterial grafts are a viable option, potentially challenging traditional approaches in emergency settings.
- The findings support the consideration of arterial grafts in urgent CABG for AMI, contributing to improved graft longevity and patient prognosis.
Abstract:
The authors conducted urgent coronary artery bypass grafting (CABG) using only arterial graft for mild and moderate acute myocardial infarction (AMI) in 9 cases from January, 1995 through December, 1996. Mild and moderate AMI means free from cardiogenic shock by catecholamines alone or catecholamines and intra aortic balloon pumping (IABP). The period from the onset of AMI to admission was 2-24 (average 8 +/- 6) hours. Coronary arteriography (CAG) was performed immediately following admission. CABG was done immediately after CAG. CPK-MB on admission was 14-184 (average 67 +/- 61) IU/l. Three cases were main trunk disease over 90% stenosis, three cases were main trunk disease equivalent if another stenotic lesion over 99% were occluded, three cases would fall into cardiogenic shock if another stenotic lesion over 99% were occluded. Postoperative IABP was necessary for three cases. No case required repetition of IABP. For minimal operation time and to attain high graft flow, saphenous vein (SV) graft are generally used for emergencies. CABG was conducted here using only arterial graft (Mean anastomosis number was 2.3). There were 8 RITA grafts, 9 LITA grafts, and 4 RGEA grafts. Post operative CAG showed all the grafts to be patent, but string sign was noted for two LITA grafts. Prognosis was favorable in all cases. We could conduct urgent CABG surgery safely for mild and moderate AMI using only arterial grafts.