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Michael A. Greene
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Ann Thorac Surg 1991;51:194-199
© 1991 The Society of Thoracic Surgeons

Articles

Emergency aortocoronary bypass after failed angioplasty

Michael A. Greene, MD*,a,b, Laman A. Gray, Jr, MDa,b, A.David Slater, MDa,b, Brian L. Ganzel, MDa,b, Constantine Mavroudis, MDa,b

a Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
b Division of Cardiothoracic Surgery, Children's Memorial Hospital, Chicago, Illinois, USA

Accepted for publication September 26, 1990.

* Address reprint requests to Dr Greene, Division of Thoracic and Cardiovascular Surgery, University of Louisville, 550 South Jackson, Louisville, KY 40202.

One thousand two hundred fourteen percutaneous transluminal coronary angioplasties were performed over a 38-month period. Sixty patients required immediate emergency coronary artery bypass grafting after angioplasty failure; 7 of these had evidence of acute myocardial infarction before angioplasty and were excluded from the study. Of the 53 patients remaining, 27 (51%) had electrocardiographic and enzyme evidence of postoperative myocardial infarction. Two patients died (4%), and 10 had postoperative complications (19%). No statistical significance was noted comparing age, sex, incidence of prior myocardial infarction or myocardial dysfunction, time for revascularization, or average number of grafts completed in those with single-vessel (n = 21) versus multiple-vessel (n = 32) coronary artery disease. Postoperatively, those with multiple-vessel disease required intraaortic balloon pump support (p = 0.06) and antiarrhythmic medications more frequently than single-vessel patients (p < 0.01) and had a higher complication rate (p < 0.05). Although not reaching statistical significance, the data also suggest a higher death and postoperative myocardial infarction rate in patients with multiple-vessel disease. Emergency coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty carries a higher morbidity and mortality than elective coronary artery bypass grafting, particularly for patients with multiple-vessel coronary artery disease.




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