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.
Andreasen
J J
JJ
Department of Cardiothoracic Surgery, Aalborg Hospital, Denmark. jjandreasen@dadlnet.dk
Mortensen
P E
PE
Andersen
L I
LI
Arendrup
H C
HC
Ilkjaer
L B
LB
Kjøller
M
M
Thayssen
P
P
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