Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery

Davorin Sef, Janko Szavits-Nossan, Mladen Predrijevac, Rajna Golubic, Tomislav Sipic, Kresimir Stambuk, Zvonimir Korda, Pascal Meier, Marko Ivan Turina

Overview

Perioperative myocardial ischaemia (MI) is associated with an increased 30-day mortality in patients undergoing isolated coronary artery bypass grafting (CABG). However, additional information on the role of immediate angiography in the case of suspected perioperative MI and the best treatment strategy would be helpful. There is still a lack of studies focused on types of bypass graft dysfunction.

Summary

In this study, we have analysed the main factors associated with perioperative MI after isolated CABG surgery and effects of coronary angiography-based treatment strategy on the patient outcome. We report that the best treatment strategy should be discussed within the heart team to determine the optimal solution for each patient. However, our results demonstrated better clinical outcomes in patients who were treated with urgent percutaneous coronary intervention (PCI).

Author Comments

Davorin Sef, MD
Davorin Sef, MD
Royal Brompton & Harefield NHS Foundation Trust
Cardiac Surgery
Harefield | United Kingdom
Urgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. However, urgent PCI may be associated with improved clinical outcome in patients with early graft failure.Davorin Sef, MD

Resources

https://openheart.bmj.com/content/6/1/e001027
https://openheart.bmj.com/content/6/1/e001027
https://www.researchgate.net/publication/332970694_Management_of_perioperative_myocardial_ischaemia_after_isolated_coronary_artery_bypass_graft_surgery
https://www.researchgate.net/publication/332970694_Management_of_perioperative_myocardial_ischaemia_after_isolated_coronary_artery_bypass_graft_surgery

Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery.

Authors:
Davorin Sef, MD
Davorin Sef, MD
Royal Brompton & Harefield NHS Foundation Trust
Cardiac Surgery
Harefield | United Kingdom

Open Heart 2019 8;6(1):e001027. Epub 2019 May 8.

Universitat Zurich, Zurich, ZH, Switzerland.

Objectives: Updated knowledge about perioperative myocardial ischaemia (MI) after coronary artery bypass grafting (CABG) and treatment of acute graft failure is needed. We analysed main factors associated with perioperative MI and effects of immediate coronary angiography-based treatment strategy on patient outcome.

Methods: Among 1119 consecutive patients with coronary artery disease who underwent isolated CABG between January 2011 and December 2015, 43 (3.8%) patients underwent urgent coronary angiography due to suspected perioperative MI. All the data were prospectively collected and retrospectively analysed. The primary endpoint was 30-day mortality; postoperative left ventricular ejection fraction) and major adverse cardiac events were secondary endpoints.Overall, 30-day mortality in patients with CABG was 1.4% while in patients who developed perioperative MI was 9% (4 patients). Angiographic findings included incorrect graft anastomosis, graft spasm, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularisation. Emergency reoperation (Redo) was performed in 14 (32%), acute percutaneous coronary intervention (PCI) in 15 (36%) and conservative treatment (Non-op) in 14 patients. Demographic and preoperative clinical characteristics between the groups were comparable. Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs 53% pre-op) and did not change in groups PCI (56% post-op vs 57% pre-op) and Non-op (58% post-op vs 57% pre-op).

Conclusions: Urgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. Urgent PCI may be associated with improved clinical outcome in patients with early graft failure.

Download full-text PDF

Source
http://dx.doi.org/10.1136/openhrt-2019-001027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519404PMC
May 2019
5 Reads

Publication Analysis

Top Keywords

coronary artery
16
myocardial ischaemia
8
artery bypass
8
30-day mortality
8
graft failure
8
perioperative myocardial
8
post-op 57%
8
coronary
7
patients
7
perioperative
5
graft
5
perioperative patients
4
events secondary
4
groups pci
4
cardiac events
4
pci 56%
4
56% post-op
4
patients angiographic
4
adverse cardiac
4
developed perioperative
4

References

(Supplied by CrossRef)
Angiographic control and percutaneous treatment of myocardial ischemia immediately after CABG
Szavits-Nossan et al.
Coll Antropol 2012

Similar Publications