Emergency coronary artery bypass surgery following failed balloon angioplasty: role of the internal mammary artery graft
| Autor: | Merrill Bronstein, Richard K. Myler, Richard E. Shaw, Alex Zapolanski, Christopher Wulff, David Ellertson, Felix G. Millhouse, Mark Zatzkis, Sharon Siegel, Simon H. Stertzer, R N Laurel Leary, D O Joseph Rosenblum, Norberto S. Schechtmann |
|---|---|
| Rok vydání: | 1991 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty medicine.medical_treatment Infarction Coronary Disease Culprit Coronary artery bypass surgery Postoperative Complications Recurrence medicine.artery Internal medicine Angioplasty medicine Humans cardiovascular diseases Myocardial infarction Prospective Studies Angioplasty Balloon Coronary Coronary Artery Bypass Internal Mammary-Coronary Artery Anastomosis Aged Aged 80 and over Ejection fraction business.industry Cardiogenic shock Hemodynamics Middle Aged medicine.disease Surgery Right coronary artery cardiovascular system Cardiology Female Emergencies Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of cardiac surgery. 6(4) |
| ISSN: | 0886-0440 |
| Popis: | During a 4-year period (1986-1989), 3,502 patients had percutaneous transluminal coronary angioplasty (PTCA) in our institution. One hundred nineteen (3.4%) patients required emergency coronary artery bypass graft surgery (CABG) because of abrupt vessel closure following PTCA. Factors associated with vessel closure included lesion angulation greater than or equal to 90 degrees (p less than 0.007), the presence of thrombus (p less than 0.02), or a long (greater than or equal to 2 cm) lesion (p less than 0.03). Of these 119 emergency CABG patients, 108 (91%) arrived in the operating room in a stable condition (group I) and 11 (9%) were in cardiogenic shock (group II). Five (45%) of the group II patients were admitted to the hospital with an acute myocardial infarction and all 11 patients had a higher incidence of multivessel disease (p less than 0.05) and lower left ventricular ejection fraction (p less than 0.001) than group I patients. The overall surgical mortality was 10.1%; however, in group I the mortality was 5.6% and in group II it was 54.5% (p less than 0.001). The vessel that abruptly closed ("culprit vessel") was the left anterior descending (LAD) in 60%, the right coronary artery in 27%, and the left circumflex in 13%. The internal mammary artery was utilized to bypass the culprit artery in 51 (43%) patients, including 50% of the culprit LADs. With group I culprit LAD patients, when the left IMA was the bypass conduit, there were no hospital deaths nor strokes and there was a 6.3% incidence of perioperative infarction. |
| Databáze: | OpenAIRE |
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