Emergency coronary artery bypass surgery after failed percutaneous transluminal coronary angioplasty.
Coronary complications caused by percutaneous transluminal coronary angioplasty (PTCA) may necessitate emergency coronary artery bypass grafting (CABG). In 1994-1998, 132 patients (1.5% of the patients registered in the Danish PTCA registry) underwent CABG within 24 h because of angioplasty complications. We reviewed the files of 86 patients who had emergency operations within 6 h and found that 35% suffered from 1-vessel disease. Fifty-eight percent were taken directly to the operating room from the cardiovascular laboratory, and 13% were given preoperative cardiovascular resuscitation. The vessels most frequently injured were the right coronary artery and the left anterior descending branch (LAD). The patients received a mean of 2.4 coronary bypasses each. Forty-three percent of the patients with lesions of the left main coronary artery and/or the LAD received a vein graft to the LAD. A perioperative Q-wave myocardial infarction developed in 51% of the patients. The in-hospital mortality rate was 12%. These results are inferior to those obtained after elective surgery. Local cardiothoracic backup is vital when PTCA is performed in an unselected patient group.
Department of Cardiothoracic Surgery, Aalborg Hospital, Denmark. jjandreasen@dadlnet.dk
J J
JJ
Andreasen
P E
PE
Mortensen
L I
LI
Andersen
H C
HC
Arendrup
L B
LB
Ilkjaer
M
M
Kjøller
P
P
Thayssen
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016887:Cardiopulmonary Resuscitation; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D003718:Denmark; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000601:surgery; D010348:Patient Care Team; D016019:Survival Analysis; D017211:Treatment Failure