Impact of Early Angiographic Evaluation on the Frequency of Emergency Reoperations after Coronary Bypass Surgery

Abstract

Results: the angiography era patients were older (64.0 years vs. 58.2 years, P = 0.002) and the proportion of female patients (22% vs. 43%, P = 0.029) was smaller. the rate of emergency reoperations decreased (0.86% vs 0.34%, P < 0.001) during the angiography era and graft repairs (P = 0.013) or additional grafts (P = 0.006) were less frequent, although occluded anastomoses were observed more often (P = 0.043). In 5 angiography era patients graft complications were corrected with percutaneous coronary intervention. Icu stay (5.72 + 0.98 days vs. 5.53 + 0.68 days) and hospital stay (12.2 + 1.54 days vs. 13.1 + 1.63 days) did not differ between the groups, but the rate of myocardial infarction (63.8% vs. 92.1%, P < 0.001) and in-hospital death (22.2% vs. 46.1%, P = 0.015) decreased.Conclusion: after the introduction of early postoperative angiographic evaluation of cabg patients the rate of emergency reoperations and related morbidity and mortality decreased.

Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis

“…All these studies reported on in-hospital or 30-day mortality after angiography followed or not by repeat revascularization. Three studies [ 7 , 9 , 11 ] reported on 48 patients who underwent repeat CABG without early angiography because of unstable hemodynamic conditions. Characteristics and main data of these studies are summarized in Table 1 .…”

“…The paucity of data on angiographic findings and on the outcome of patients treated conservatively because of negative angiographic findings or lack of suitable target vessels/grafts for repeat revascularization render the interpretation of these pooled results even more difficult. However, Karhunen et al [ 9 ] showed that a policy of control angiography in PMI patients was associated with a dramatic decrease of postoperative mortality when compared with an historical control group who did not undergo any control angiography for PMI (22.2% vs. 46.1%, p=0.015). Therefore, we may assume that in most of cases on-going severe myocardial ischemia secondary to any graft or new native vessels problem cannot be relieved by a conservative approach [ 6 ] and is associated with poor early and mid-term outcome.…”

Angiography for Management of Perioperative Myocardial Ischemia: Does it Have Any Role?

“…1 When confronted with postoperative MI and ECG changes, some institutions propose to take these patients directly to the operating room. 17 One of the important limitations of our study is the overlap between patients who had myocardial infarction and MI. In addition, this would mean unnecessary reoperation in a significant proportion of patients, as seen in our study, in which almost one third of the patients did not require intervention and were treated satisfactorily with medical management.…”

“…4 Moreover, the incidences of sudden hemodynamic collapse and emergency reoperations are lower when angiography is used more liberally for assessment of ischemia in the perioperative period. 17 One of the important limitations of our study is the overlap between patients who had myocardial infarction and MI. This is primarily because of small numbers of patients in the study group (n = 26) and also because the threshold for significance for troponin was reached only in eight patients and only two deaths were seen in the study population.…”

Postcardiac surgery myocardial ischemia: Why, when, and how to intervene

“…Although it is preferable that this is expeditiously agreed by the Heart Team, composed of the cardiac surgeon, anesthetist, or intensive care unit physician and interventional cardiologist (Figure 1), this must not cause delays. 7,12,13 Reluctance to formally investigate potential PMI in favor of inotropic or mechanical support (eg, intra-aortic balloon pump) should be strongly resisted.…”