[Emergency coronary artery bypass grafting for severe ischemia in patients with left main trunk disease].
Between Jan. 1994 and Feb. 1998, thirty-eight patients underwent emergency coronary artery bypass grafting (CABG) for severe left main trunk (LMT) disease. The age ranged from 45 to 87 (mean 69.8), including 10 patients over 80 years. Surgical indications were: acute myocardial infarct (AMI) due to acute occlusion of LMT (LMT-AMI) in 7, unstable angina with severe LMT stenosis (LMT-UAP) in 19, AMI due to branch occlusion with severe LMT stenosis (AMI with LMT) in 10, and chronic LMT occlusion with ongoing congestive heart failure (LMT-OMI) in 2 patients. Five of the 7 patients with LMT-AMI were successfully resuscitated from ventricular fibrillation at the emergency room in 2 (cardio-pulmonary arrest on arrival), and at the cathe-room in 3 patients. For these patients, percutaneous cardiopulmonary support system + intra aortic balloon pump (IABP) were required in 3, and IABP in 2 patients before or during catheter intervention. LMT was then recanalized by catheter intervention prior to CABG. Operative mortality were 28.6% (2/7) in LMT-AMI, 20% (2/10) in AMI with LMT, 0% (0/19) in LMT-UAP, and 50% (1/2) in LMT-OMI. Five of the 7 patients with LMT-AMI, survived the most hazardous condition of left main shock syndrome. Quick establishment of the circulatory support and recanalization of LMT by catheter intervention prior to CABG are the key factors for saving their lives.
Minato
N
N
Department of Thoracic and Cardiovascular Surgery, Fukuoka Tokushukai Hospital, Japan.
Ikeda
K
K
Fujita
H
H
D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000473:pathology; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology / Q000601:surgery*