Differences Between Early, Intermediate, and Late Angioplasty After Coronary Artery Bypass Grafting

Abstract

The aim of the present study was to identify patients with recurrent ischemia after coronary artery bypass surgery (CABG) treated by percutaneous coronary intervention (PCI). Graft failure after CABG may be managed conservatively or treated by surgery or PCI. We thought to investigate clinical, angiographic, and procedural characteristics in relation to clinical outcome. This was a retrospective single-center study. Patients who underwent revascularization by PCI with a previous CABG were analyzed. Patients were divided in 3 groups, depending on interval between CABG and index PCI: group 1, interval <72 hours; group 2, interval between 72 hours and 1 year; group 3, interval >1 year. Two hundred twenty-one patients were studied. Clinical characteristics and survival curves were comparable in groups 2 and 3. Postoperative creatine kinase MB and troponin values were significantly higher in group 1 (P = 0.000). From group 1, significantly more patients (10.5%) required emergency CABG after the index PCI than compared with group 2 (2.1%) and group 3 (0%), (P = 0.003). There were more off-pump CABGs in group 1 than in the other 2 groups. Group 1 received less PCIs in native ungrafted vessels compared with the other 2 groups. Mortality in group 1 (18.4%) was higher than in the other 2 groups (7.4 and 4.5%, respectively; P < 0.05). Mortality in group 1 was higher in the acute phase of follow-up. PCI performed less than 72 hours after CABG is feasible but accompanied by a higher mortality and redo CABG. This outcome is probably related to the high-risk patient category.

Intraoperative graft flow assessment for myocardial surgical revascularization

“…However, the major drawback of this technique was that the measured values were strongly influenced by many different variables such as hematocrit, vessel diameter, device calibration issues, and motion artifacts. The introduction of epicardial high-resolution ultrasonography (HR-US) in the 1980s and TTFM in the 1990s, in addition to the widespread use of off-pump CABG, renewed the interest in intraoperative graft assessment after more than 30 years of development and improvement in various intraoperative flow assessment methods [8] . HR-US, as it is known nowadays, has been used in standard fashion since it was introduced in 2012.…”

“…In 2012, Medistim ASA introduced the VeriQC machine at the annual meeting of the European Association of Cardio-Thoracic Surgery in Barcelona. It was the first device that incorporated TTFM with HR-US using a re-sterilizable HR-US probe [8] . Several manufacturers now offer different models of HR-US probes and devices.…”

“…Moreover, in this study, TTFM parameters were not associated with postoperative serum cardiac enzyme levels and did not correlate with the occurrence of death, myocardial infarction, or stroke. As a general rule, the following values are generally accepted for adequate bypass graft function: (1) flow > 15 mL/min; (2) PI < 5.0 is acceptable, but < 3.0 is ideal; and (3) DF = 60%-80% for grafts to the left coronary tree and 45%-55% for the right coronary circulation [8] . Table 2 shows several reported cut-offs for TTFM parameters according to the experience of different groups [29][30][31][32] .…”

“…Therefore, the quality of the native target vessel should always be taken into consideration while interpreting the TTFM measurements. Furthermore, TTFM used in isolation may not be accurate enough, since 10%-15% of grafts assessed reveal ambiguous or inconclusive results [8] . Hence, the combined Di Giammarco et al [29] (2006) MGF ≤ 15 mL/min; PI ≥ 3 94 61…”

Influence of flowmetry on the outcomes of coronary artery bypass surgery

“…лее простым и информативным методом диагностики в настоящее время является определение транзитного времени кровотока по шунтам согласно современным рекомендациям по реваскуляризации миокарда (класс рекомендации I, уровень доказательности С) [4]. Интраоперационное обнаружение и устранение проблем с коронарными шунтами является одним из самых главных условий по улучшению результатов коронарного шунтирования [3,4]. В настоящее время нет конкретных рекомендаций по количественной оценке объемной скорости кровотока по коронарным шунтам.…”