Emergency repeat myocardial revascularization after coronary artery bypass grafting
Abstract
Background. Perioperative myocardial infarction associated with acute dysfunction
of coronary artery bypass grafts in the early postoperative period is one of
the most severe complications of coronary artery bypass grafting. In addition
to the complex differential diagnosis, the optimal treatment strategy for this
condition remains uncertain. Currently, according to most researchers, it is
necessary to resort to the most rapid re-invasive intervention, but the
preferred type of intervention remains unclear.
Aim. Conducting a comparative analysis of in-hospital and long-term mortality
in patients after elective coronary artery bypass grafting who underwent
re-intervention surgically or using endovascular technology in the early
postoperative period due to dysfunction of coronary bypass grafts.
Material and
methods. Among 8801 patients who in the period from 2011 to
2021 underwent coronary artery bypass grafting 196 (2.23%) patients underwent
emergency coronary artery bypass grafting at the Federal State Budgetary
Institution “FTSSSH” of the Ministry of Health of the Russian Federation
(Chelyabinsk). Of these, 86 (43.9%) patients underwent re-intervention due to
acute dysfunction of coronary bypass grafts. Group I included 26 patients who
underwent open re-intervention, group II included 60 patients who underwent
endovascular correction. The primary endpoint was in-hospital mortality; the
secondary endpoints were long-term mortality and adverse cardiovascular events
(myocardial infarction, stroke, repeated myocardial revascularization).
Communication with patients was carried out using telephone interviews.
Results. Hospital mortality in the reoperation group was 3.8%, in the
endovascular treatment group 10%, no statistical differences were found (p=0.67)
group I and group II, no statistically significant differences were found,
96.5±5.2 months. versus 106.5±5.8 months (log-rank test, p=0.53) and
95.9±5.4 months. versus 98±4.4 months (log-rank test, p=0.564),
respectively. In a multivariate analysis, the predictors of in-hospital
mortality were hemodynamically significant carotid artery stenosis (p=0.026),
cardiopulmonary bypass time (p=0.036), re-exploration due to bleeding (p=0.001),
and the need for hemodialysis (p<0.001).
When conducting a
multivariate Cox regression analysis in patients of group II (endovascular
correction), the presence of a history of stroke and AF was accompanied by an
increase in the risk of long-term mortality by 18.5 and 38 times, respectively.
A decrease in LV EF at the time of discharge by 1% – an increase in the risk of
death by 1/0.861 times, an increase in the time to coronary angiography from
the results of the first analysis for Troponin by 1.026 times, an increase in
time in intensive care by 1 day by 1.071 times. In the group of patients who
underwent repeated open surgery, a 1% decrease in LV EF increased the risk of
outcome by 1/0.842 times (p=0.041, 95% CI 0.714–0.993).
Conclusion. Emergency coronary angiography allows to establish the causes of
perioperative myocardial infarction and, if a violation of coronary blood flow
is detected, it can be eliminated in a timely manner. Hospital, long-term
mortality and adverse cardiovascular events were comparable between groups with
different methods of repeated revascularization.
Keywords:coronary artery bypass; myocardial infarction; postoperative complications
Funding. The study had no sponsor support.
Conflict of
interest. The authors declare no conflict of interest.
For citation: Semagin A.A., Aminov V.V., Lukin O P., Fokin A.A. Emergency repeat
myocardial revascularization after coronary artery bypass grafting. Clinical
and Experimental Surgery. Petrovsky Journal. 2024; 12 (1): 60–7. DOI: https://doi.org/10.33029/2308-1198-2024-12-1-60-67
(in Russian)
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