Impact of early angiographic evaluation on the frequency of emergency reoperations after coronary bypass surgery.
OBJECTIVE
early graft failure following coronary bypass surgery results in elevated morbidity and mortality. This study focused on the impact of angiographic graft evaluation.


METHODS
of 5251 coronary artery bypass grafting (CABG) patients, 36 with postoperative persistent ischaemia underwent early angiography (23) or emergency resternotomy (13) 2000-2007 (Angiography era). Of the 23 patients, who underwent angiography, five were subsequently reoperated. Of 8807 CABG patients, 76 underwent postoperative emergency resternotomy 1988-1999 (Pre-angiography era) and served as controls.


RESULTS
the angiography era patients were older (64.0 years vs. 58.2 years, P = 0.002) and the proportion of female patients (22% vs. 43%, P = 0.029) was smaller. The rate of emergency reoperations decreased (0.86% vs 0.34%, P < 0.001) during the Angiography era and graft repairs (P = 0.013) or additional grafts (P = 0.006) were less frequent, although occluded anastomoses were observed more often (P = 0.043). In 5 Angiography era patients graft complications were corrected with percutaneous coronary intervention. ICU stay (5.72 + 0.98 days vs. 5.53 + 0.68 days) and hospital stay (12.2 + 1.54 days vs. 13.1 + 1.63 days) did not differ between the groups, but the rate of myocardial infarction (63.8% vs. 92.1%, P < 0.001) and in-hospital death (22.2% vs. 46.1%, P = 0.015) decreased.


CONCLUSIONS
after the introduction of early postoperative angiographic evaluation of CABG patients the rate of emergency reoperations and related morbidity and mortality decreased.
Department of Orthopaedics and Traumatology, Jorvi Hospital, Espoo, Finland. janne.karhunen@hus.fi
J
J
Karhunen
P
P
Raivio
P
P
Maasilta
E
E
Sihvo
R
R
Suojaranta-Ylinen
A
A
Vento
U S
US
Salminen
D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011182:Postoperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D056346:Sternotomy