Surgical treatment of interventional coronary angiographic accidents.
Newer methodologies have increased the incidence of coronary interventions. At the authors' institution, 5,614 coronary interventional procedures (28% of all catheterizations) were performed over a 3-year period, from 1995 to 1997. Eighty-one patients (1.4%) suffered angiographic accidents, including coronary artery dissection, free rupture, tamponade, foreign body embolism, and wire entrapment, and were retrospectively reviewed. All patients were taken for emergency surgery in less than 4 hours. The mean age was 61.2 years, 44 (54%) were men, and 37 (46%) were in cardiogenic shock at the time of surgery. Fifty-seven patients (70%) had intraaortic balloon counterpulsation. The number of previous cardiac interventions ranged from one to four with a mean of 1.9. One to five bypass grafts (mean, 2.2) were performed, and three patients required temporary ventricular assist devices. There were six deaths for a 30-day mortality rate of 7.4%. Thirty-two patients (39.5%) suffered significant morbidity, including cerebrovascular accidents, and renal and respiratory failure. Perioperative myocardial infarctions were diagnosed in 39 (48%) patients. Average length of stay was 12.1 days. One-year survival was satisfactory at 90% (73/81), with 56 survivors (77%) regaining normal everyday activity. Early surgical intervention, rapid revascularization, and temporary mechanical support are keys to low mortality in this high-risk group. Identification of high-risk interventions and significant comorbid conditions, with concomitant surgical consultation, need to be pursued to reduce the high morbidity rate.
Morris
R J
RJ
University of Pennsylvania Health Systems, and Department of Cardiothoracic Surgery, Hahnemann University Hospital, Philadelphia, USA.
Kuretu
M L
ML
Grunewald
K E
KE
Samuels
L E
LE
Strong
M D
MD
Wechsler
A S
AS
D000203:Activities of Daily Living; D000784:Aortic Dissection / Q000209:etiology / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D017225:Atherectomy, Coronary / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D003323:Coronary Aneurysm / Q000209:etiology / Q000601:surgery; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000209:etiology / Q000601:surgery*; D004617:Embolism / Q000209:etiology / Q000601:surgery; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000209:etiology / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D051437:Renal Insufficiency / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology; D020521:Stroke / Q000209:etiology; D015996:Survival Rate