[Cardiosurgical stand-by and acute interventions after interventional cardiologic procedures].
Interventional cardiologists and cardiac surgeons agree in the treatment of symptomatic coronary artery stenosis: high risk patients with severe coronary disease (such as left main stem stenosis, triple vessel disease and double vessel disease with involvement of the proximal LAD in particular with severely impaired ventricular function) are treated preferentially with coronary artery bypass grafting (CABG); less severe cases allow alternatively PTCA treatment. However, even in controlled and randomised studies (RITA, GABI, ERACI, CABRI, and BARI-studies) looking into these alternatives (PTCA versus CABG) it was found that 1.1% to 10.1% of all PTCA incidents required a surgical emergency procedure. Although, in favourable conditions the risk is considerably lower than the above value and despite of improvement of catheter techniques (stent implantation, perfusion catheters) in less favourable conditions which reduced the risk to a similar value, the results of surgical emergency procedures are still significantly impaired compared with elective procedures. Moreover it has been shown that there is a relation between the outcome of the surgical procedure and the time elapsed between PTCA-incident and surgical intervention. Perioperative myocardial infarction and mortality are much lower if there is no delay caused by occupied theaters, unsolved transportation problems and/or time intensive attempts of recanalisation by catheter. Considering the high numbers of PTCA procedures, in some centers even performed simultaneously, it seems acceptable to perform a dilatation in the low risk group without surgical standby. If strict observance of the indication criteria is provided early complication rate and mortality of PTCA is even less than in CABG-procedures. On the other hand (from a cardiosurgical point of view), it has to be emphasized that PTCA procedures in the high risk group potentially endangering large myocardial areas, a cardiosurgical standby has to be available and emergency surgery should be performed ultimately within 60 minutes (after myocardial infarction).
Oelert
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Klinik für Herz-, Thorax- und Gefässchirurgie, Universitätskliniken Mainz.
D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004630:Emergencies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D010348:Patient Care Team; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D015996:Survival Rate; D017211:Treatment Failure
Kardiochirurgisches Stand-by und Akuteingriffe nach interventionellen kardiologischen Massnahmen.