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DOI: 10.1055/s-2004-816577
Emergency reintervention in patiens with acute graft failure following coronary artery bypass surgery
Objectives: Acute graft failure after CABG is a life-threatening complication, which is proposed to be treated by emergent reintervention to limit myocardial damage, thus preserving ventricular function, which in turn is the most important determinant of patient outcome.
Material and Methods: Between 01/2000 and 09/2003, coronary angiography was emergently performed in 71 of 3542 consecutive CABG patients with evidence of acute perioperative myocardial infarction (PMI) to elucidate mechanisms causing PMI, and to assess feasibility of subsequent reintervention. As a result, patients subsequently underwent acute PCI (group A), were taken to emergency (group B) or immediate reoperation (group C), or a reinterventional approach was renounced (group D).
Results: PMI was caused by acute graft failure in 41/71 patients. Fifty-two out of 135 grafts were failing. Of these, 40 grafts were occluded, 7 grafts had subtotal stenotic anastomosis, and 5 grafts were kinked. Eleven of 41 patients (27%) were treated by subsequent PCI with stenting of native coronary arteries (7 LAD, 5 LCx), whereas 13 of 41 patients (32%) were readmitted to emergency (2.7±2.1h after angiography) or immediate reoperation (114±110h after angiography). Thirty-day and 1-year mortality was 18% (2/11) and 18% (2/11) in group A, 11% (1/9) and 22% (2/9) in group B, 50% (2/4) and 50% (2/4) in group C, and 18% (3/17) and 24% (4/17) in group D, respectively.
Conclusions: Acute repeat angiography with subsequent reintervention in patients with PMI after CABG is a high-risk but reliable approach. If surgical redo is neccessary, patients should underwent re-CABG within a minimum of time.