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Abstract: Poster Presentations |

RESCUE PERCUTANEOUS CORONARY INTERVENTION, REOPERATION, OR CONSERVATIVE TREATMENT IN ACUTE PERIOPERATIVE GRAFT FAILURE AFTER CORONARY ARTERY BYPASS SURGERY FREE TO VIEW

Matthias Thielmann, MD*; Parwis Massoudy, MD; Guenter Marggraf, MD; Beate Jaeger, MD; Stefan Sack, MD; Raimund Erbel, MD; Heinz Jakob, MD
Author and Funding Information

Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University, Essen, Germany


Chest


Chest. 2005;128(4_MeetingAbstracts):274S. doi:10.1378/chest.128.5.3526
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Abstract

PURPOSE:  Perioperative graft failure after coronary artery bypass surgery (CABG) results in acute myocardial infarction (PMI), which necessitates acute re-revascularization to salvage myocardium, thus preserving ventricular function and improving patient outcome. Whether rescue percutaneous coronary intervention (PCI), emergency reoperation, or conservative intensive care treatment should be applied is currenly unknown.

METHODS:  Perioperative graft failure after coronary artery bypass surgery (CABG) results in acute myocardial ischemia/infarction (PMI), which necessitates acute re-revascularization to salvage myocardium, thus preserving ventricular function and improving patient outcome. Whether rescue percutaneous coronary intervention (PCI), emergency reoperation, or conservative intensive care treatment should be applied is currenly unknown.

RESULTS:  Repeat coronary angiography 4 (1-10) hrs (median and range) after the onset of symptoms revealed acute perioperative bypass graft failure in 73 patients and 98 out of 258 bypass grafts after CABG. The number and type of failing grafts were comparable between groups 1 and 2, but significantly different to group3 (P<0.001). Acute PCI was applied in 27 patients, reoperation in 18 patients, and conservative intensive care treatment in 28 patients. Maximum postoperative cTnI levels were significantly different between groups 1 and 2 (92±16 versus 205±42 ng/mL; P<0.001). Left ventricular ejection fraction was reduced during the acute event compared to preoperative values (P<0.01) and significantly improved during follow-up within each group (P<0.02), but did not differ between the groups. In-hospital and 1-year mortality were 14.8% and 22.2% in group 1, 27.8% and 33.3% in group 2, and 14.3% and 28.6% in group 3, respectively (P=NS).

CONCLUSION:  Re-revascularization with rescue PCI was succesfull to relieve acute myocardial ischemia and decreased the extent of myocardial cellular damage. However, no statistically significant difference could be observed between different re-revascularization strategies in terms of left ventricular function and short- and mid-term outcome.

CLINICAL IMPLICATIONS:  The cardiac cathlab should routinely be available to identify the underlying mechanism of PMI after CABG and to reintervene immediately in case of acute graft failure.

DISCLOSURE:  Matthias Thielmann, None.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM


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