[Complete arterial revascularization in emergency CABG].
Between August 1987 and November 1998, 137 patients underwent emergency CABG within 24 hours from the notification of cardiologist. Among them, 37 patients (27%) (34 men, 3 women) with a mean age of 59.9 (range, 39-76) underwent multiple CABG with exclusive use of arterial conduits. Preoperative diagnosis was acute myocardial infarction in 20 patients and unstable angina in 17 patients. Twenty-nine patients (78%) had either triple vessel or left main disease. There were 3 redo CABG and 3 patients were on hemodialysis. Postoperative follow-up averaged 44 months. Twenty-nine patients (78%) were under IABP support preoperatively. The mean number of anastomoses was 2.65 (range, 2-5). One patient (2.7%) died of persistent heart failure 54 days postoperatively. The patency was confirmed angiographically in 33 patients 3-4 weeks after surgery. Overall patency was 90.6% (LITA: 93.0%, RGEA: 76.2%, RITA, radial: 100%). There were no late deaths or redo CABG, and 2 patients sustained myocardial infarction and 3 patients underwent PTCA during follow-up. Five-year actuarial survival rate was 97.1% and cardiac event-free rate was 75.7%. These excellent early and long-term results suggest that complete arterial grafting for emergency CABG should be considered as a primary treatment in patients who have multivessel or left main disease, and no ongoing profound cardiogenic shock or rapid deterioration.
Nishida
H
H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Tomizawa
Y
Y
Endo
M
M
Koyanagi
H
H
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery