title: Outcome in Patients Having Salvage Coronary Artery Bypass Grafting.
abstract: Salvage coronary artery bypass grafting (CABG) is often performed for cardiogenic shock on compassionate basis without clinical data justifying this aggressive approach. The aim of this study was to analyze early and intermediate outcomes after salvage CABG. We retrospectively reviewed the data of 85 patients who underwent salvage CABG at 11 European cardiac surgery centers. Salvage CABG was defined according to the EuroSCORE criteria, that is, a procedure performed in patients requiring cardiopulmonary resuscitation (external cardiac massage) en route to the operating theater or before induction of anesthesia. A percutaneous coronary intervention procedure preceded salvage CABG in 55 patients (64.7%). Thirty patients (35.3%) died during the inhospital stay. The mean EuroSCORE II was 32.0% and the observed-to-expected ratio was 1.08. Salvage CABG was associated with high rates of postoperative stroke (9.4%), resternotomy for bleeding (23.5%), resternotomy for hemodynamic instability (15.3%), dialysis (18.8%), severe gastrointestinal complications (12.9%), and deep sternal wound infection (10.6%). Survival at 1, 3, and 5 years was 58.6%, 49.8%, and 40.9%, respectively. Twenty patients (23.5%) were postoperatively treated with extracorporeal membrane oxygenation (ECMO). The rates of adverse events after ECMO were particularly high (stroke 40%, resternotomy for bleeding 60%, dialysis 35%, gastrointestinal complications 30%, and deep sternal wound infection 30%). Of patients treated with ECMO, 8 (40%) survived to discharge, and 1-year survival was 29.2%. Salvage CABG is associated with high risk of immediate mortality and severe adverse events. However, the observed immediate and intermediate outcome justify coronary surgery in these critically ill patients. A number of these patients are currently treated by ECMO, and its results are encouraging.
authors: Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany. Electronic address: g.santarpino@libero.it.
authors: Giuseppe
authors: G
authors: Santarpino
authors: Department of Thoracic and Cardiovascular Surgery, University Hospital Pontchaillou, Rennes, France.
authors: Vito G
authors: VG
authors: Ruggieri
authors: Cardiac Surgery, University of Leicester, Glenfield Hospital, Leicester, United Kingdom.
authors: Giovanni
authors: G
authors: Mariscalco
authors: Department of Thoracic and Cardiovascular Surgery, University Hospital Pontchaillou, Rennes, France.
authors: Karl
authors: K
authors: Bounader
authors: Department of Heart and Vessels, Cardiac Surgery Unit, Ospedale di Circolo, Varese, Italy.
authors: Cesare
authors: C
authors: Beghi
authors: Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
authors: Theodor
authors: T
authors: Fischlein
authors: Division of Cardiac Surgery, University of Verona, Verona, Italy.
authors: Francesco
authors: F
authors: Onorati
authors: Division of Cardiac Surgery, University of Verona, Verona, Italy.
authors: Giuseppe
authors: G
authors: Faggian
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Giuseppe
authors: G
authors: Gatti
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Aniello
authors: A
authors: Pappalardo
authors: Department of Cardiothoracic and Respiratory Sciences, V. Monaldi Hospital, Naples, Italy.
authors: Marisa
authors: M
authors: De Feo
authors: Department of Cardiothoracic and Respiratory Sciences, V. Monaldi Hospital, Naples, Italy.
authors: Ciro
authors: C
authors: Bancone
authors: Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
authors: Andrea
authors: A
authors: Perrotti
authors: Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
authors: Sidney
authors: S
authors: Chocron
authors: Department of Cardiothoracic Surgery and Anesthesia, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: Magnus
authors: M
authors: Dalen
authors: Department of Cardiothoracic Surgery and Anesthesia, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: Peter
authors: P
authors: Svenarud
authors: Cardiac Surgery Unit, A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy.
authors: Antonino S
authors: AS
authors: Rubino
authors: Cardiac Surgery Unit, A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy.
authors: Carmelo
authors: C
authors: Mignosa
authors: Department of Cardiac Surgery, S.Camillo Hospital, Rome, Italy.
authors: Riccardo
authors: R
authors: Gherli
authors: Department of Cardiac Surgery, S.Camillo Hospital, Rome, Italy.
authors: Francesco
authors: F
authors: Musumeci
authors: Department of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors: Angelo M
authors: AM
authors: Dell'Aquila
authors: Department of Surgery, University of Oulu, Oulu, Finland.
authors: Eeva-Maija
authors: EM
authors: Kinnunen
authors: Department of Surgery, University of Oulu, Oulu, Finland.
authors: Fausto
authors: F
authors: Biancari
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D005060:Europe; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome