[Surgical results of emergency coronary artery bypass grafting: effect of left main trunk lesion]
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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
1Department of Cardiovascular Surgery, Toho University School of Medicine, Tokyo, Japan.
Insights
Emergency coronary artery bypass grafting (CABG) carries higher risks, especially with acute myocardial infarction (AMI). Prompt revascularization in left main trunk (LMT) lesions may improve outcomes in these critical cases.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Emergency Cardiac Procedures
Context:
- Emergency coronary artery bypass grafting (CABG) presents increased risks compared to elective procedures.
- Left main trunk (LMT) lesions in emergency CABG are associated with higher rates of cardiogenic shock and poorer operative results.
- A significant mortality difference exists between emergency CABG (17.8%) and elective CABG (2.8%).
Purpose:
- To analyze the outcomes and identify risk factors for mortality in patients undergoing emergency CABG.
- To evaluate the specific impact of left main trunk (LMT) lesions on emergency CABG outcomes.
- To compare the mortality rates of emergency versus elective CABG procedures.
Summary:
- This study analyzed 45 patients undergoing emergency CABG between 1989 and 1995.
- Acute myocardial infarction (AMI) was identified as a significant independent risk factor for mortality (Odds Ratio 12.4).
- While LMT lesions presented severe cases, the mortality rate (8.3%) was not significantly higher than other emergency CABG cases, suggesting timely revascularization is key.
Impact:
- Identifies acute myocardial infarction (AMI) as a critical predictor of mortality in emergency CABG.
- Suggests that prompt revascularization for left main trunk (LMT) lesions in emergency settings can lead to comparable outcomes to other emergency CABG procedures.
- Highlights the elevated risks associated with emergency CABG compared to elective surgery, emphasizing the need for rapid intervention.
Abstract:
Emergency coronary artery bypass grafting has higher risk than elective surgery. Furthermore, if a lesion is located at left main coronary artery, the frequency of cardiogenic shock or high risk patient would be greater, and operative results would be worse. Between January, 1989 and December, 1995, 45 patients who underwent emergency CABG were included. Age ranged 44 to 80 years (mean 67 +/- 7.6 years; 31 men, 14 women). Of 45 cases, 12 cases were patients with LMT lesion. Results were analysed by univariate analysis and multivariate logistic analysis. Of 45 emergency cases, 5 were operative death and 3 were hospital death. Mortality rate was 17.8%, which was significantly higher than the mortality of elective CABG (2.8%) during the same period (p < 0.001). A factor that influenced the mortality was acute myocardial infarction (AMI), which was confirmed by both univariate and multivariate logistic analyses. Odds ratio (relative risk) was 12.4 for AMI. Only one patient died in 12 cases with LMT (8.3%). This case was due to complication after catheter intervention possibly caused by MOF. Thus, the relative risk of LMT was not so high (p = n.s). Other factors showed no significant correlation. Although the emergency case of LMT lesion was generally severe, we could have the same result as other emergency surgeries when patients were revascularized as soon as possible.
