Abstract
Objective: To analyze the effect of immediate treatment of perioperative myocardial ischemia due to early graft failure in patients undergoing coronary artery bypass surgery (CABG). Patients and methods: Between January 2004 and December 2010, 7489 patients underwent isolated CABG at our institution. All patients (n=427, 5.7%) who showed evidence of perioperative myocardial ischemia (PMI) underwent emergent coronary angiography. PMI was characterized by an isoenzyme ratio of creatinine phosphokinase (CK/CK-MB) > 10% and/or new ST-segment changes and/or recurrent episodes of ventricular tachycardia or fibrillation and/or hemodynamic deterioration with new regional wall motion abnormalities on echocardiography. One thousand and thirteen grafts and 1131 distal anastomoses were examined angiographically. Results: One hundred and seventy-six patients had a normal postoperative coronary angiography. Two hundred and fifty-one patients had stenoses or occlusions of 372 grafts. Revision CABG (group A) or percutaneous coronary intervention (PCI) (group B) was performed in 130 (51.8%) and 31 (12.4%) patients with graft stenosis or occlusion, respectively. Conservative therapy was implemented in 92 (36.6%) patients (group C). In-hospital mortality was 8.4% and 2.9% in patients with and without PMI (p < 0.001). In the former group, in-hospital mortality was 10.4% and 5.7% in patients with and without graft failure, respectively (p=0.087). There was no difference in early and long-term survival between the 3 treatment groups for graft failure (p=0.8). On the other hand, 1- and 5-year survival in patients with no PMI (93.3±0.03% and 83.6±0.05%, respectively) was significantly better than those with PMI (92.3±0.1% and 82.4±0.2%, respectively) [p<0.001 log rank]. When in-hospital mortality was excluded, there was no difference (p=0.1) in long-term survival between patients with and without perioperative myocardial ischemia. Conclusions: Perioperative ischemia is associated with increased in-hospital mortality in patients undergoing isolated coronary bypass surgery. Expeditious treatment of bypass graft stenosis or occlusion results in similar long-term survival to non-ischemic patients in hospital survivors.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
