Korean J Thorac Cardiovasc Surg.  2007 Mar;40(3):209-214.

Clinical Outcome of Emergency Coronary Artery Bypass Grafting after Failed Percutaneous Transluminal Coronary Angioplasty

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Korea. kangms@yumc.yonsei.ac.kr

Abstract

BACKGROUND: Failed percutaneous transluminal coronary angioplasty (PTCA) is occasionally required for emergency coronary artery bypass grafting (CABG). The aim of this study was to assess the outcome of patients receiving emergency CABG after failed PTCA. MATERIAL AND METHOD: Between May 1988 and May 2005, 5712 patients underwent PTCA, where 84 (1.4%) failed. 27 patients underwent emergency CABG after failed PTCA. The mean age was 63.7+/-8.9 (46~80) years, with 14 male patients (51.9%). RESULT: All patients underwent emergent surgical revascularization within 6 hours. 22 patients underwent conventional CABG and 5 underwent off-pump CABG. The causes of PTCA failure were coronary obstruction due to new thrombi formation during the procedure (n=4), coronary dissection (n=17), coronary artery rupture (n=3) and 3 due to other causes. The rate of in-hospital operative mortality after emergent operation was 18.5% (5/27). A univariate analysis revealed that patients who died more often had left anterior descending artery disease, a preprocedural shock status, postoperative use of multiple isotropics and postoperative use of intra-aortic balloon pump. The mean follow up duration was 53.6+/-63.4 months.
CONCLUSION
Although PTCA is known to be life saving, there is still a high risk for morbidity and mortality following emergency CABG after failed PTCA, despite the advancement in PTCA techniques. This result will help identify and more effectively treat patients selected for PTCA when emergency CABG is required.

Keyword

Angioplasty, transluminal, percutaneous coronary; Coronary artery bypass surgery

MeSH Terms

Angioplasty*
Angioplasty, Balloon, Coronary
Arteries
Coronary Artery Bypass*
Coronary Vessels*
Emergencies*
Follow-Up Studies
Humans
Male
Mortality
Rupture
Shock
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