engleski

Management of perioperative myocardial ischaemia after isolated CABG

OBJECTIVES: Perioperative myocardial ischaemia is a rare but serious complication after coronary artery bypass grafting (CABG), which may necessitate an immediate secondary reintervention procedure to preserve ventricular function and improve patient’s outcome. The best approach for the treatment of acute graft failure is still controversial. The purpose of this study was to analyse the main factors associated with perioperative ischaemia and effects of immediate coronary angiography-based treatment strategy on the patient outcome. METHODS: Among 1119 patients with coronary artery disease who consecutively underwent isolated CABG between January 2011 and December 2015 we identified 43 (3.8%) patients that underwent immediate coronary angiography due to the suspected perioperative myocardial ischaemia in a prospective study. Creatine kinase (CK-MB) and 12- lead standard electrocardiography were evaluated after CABG in all patients. Angiographic findings including incorrect graft anastomosis, graft spasm, displacement, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularization were analysed. As a result, patients underwent emergency reoperation (Redo), acute percutaneous coronary intervention (PCI) or were treated conservatively (Non-op). Primary endpoint was 30-days mortality. Postoperative left ventricular ejection fraction and major adverse cardiac events were secondary endpoints. RESULTS: Immediate redo-CABG (Redo) was performed in 14 patients (32%), (PCI) in 15 patients (36%), and conservative treatment (Non-op) in 14 patients. 30-days mortality was 9% (4 patients). Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs. 60% pre-op) due to perioperative MI when compared with groups PCI and Non-op (60% post-op vs. 60% pre-op). CONCLUSIONS: Suspected diagnosis of perioperative MI should indicate prompt coronary angiography with emergency reintervention in the case of acute graft failure to limit the extent of myocardial damage after CABG. Urgent PCI may be associated with better outcome in patients with early graft failure after CABG when compared to re-operation.

Perioperative myocardial ischaemia, coronary artery bypass grafting

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