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01-01-2009 | original article | Uitgave 1/2009

Netherlands Heart Journal 1/2009

Clinical significance, angiographic characteristics, and short-term outcomes in 30 patients with early coronary artery graft failure

Tijdschrift:
Netherlands Heart Journal > Uitgave 1/2009
Auteurs:
S. S. Virani, M. Alam, C. E. Mendoza, H. Arora, A. C. Ferreira, E. de Marchena
Belangrijke opmerkingen
Division of Cardiology, Texas Heart Institute, St Lukes Episcopal Hospital, Houston, Texas, USA
Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida, USA
Division of Cardiology, Texas Heart Institute, St Lukes Episcopal Hospital, Houston, Texas, USA
Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida, USA
S.S. Virani Division of Cardiology, Saint Luke’s Episcopal Hospital, 6720 Bertner Avenue, P332 Houston, TX 77030, USA

Abstract

BackgroundDespite technical advances in coronary artery bypass grafting (CABG), early postoperative myocardial ischaemia still remains a challenging problem. The aim of this study was to determine the incidence, clinical features, angiographic characteristics, and management of early graft failure in the present CABG era.
MethodsBetween January 1997 and December 2002, 1731 patients underwent CABG at our institution. Coronary angiography was performed in patients with clinical evidence of early postoperative ischaemia (≤3 months). Thirty of these patients with graft failure constituted the population of this study.
ResultsOff-pump and on-pump CABG were almost evenly performed in these patients [n=16 (53%) and n=14 (47%) respectively]. Acute myocardial infarction and unstable angina were the leading indications for coronary angiography in the majority of patients [n=28 (93%)]. The most common cause of graft failure was occlusion / thrombosis [n=20 (67%)]. Percutaneous coronary intervention (PCI) was offered to the majority of patients [n=22 (73%)]. Of these patients, 14 underwent PCI to native coronary arteries, whereas eight underwent PCI to the culprit vessel. Three patients underwent reoperation, and five received medical management. Four patients (13%) died in hospital (two after redo CABG, one after unsuccessful PCI, and one patient managed medically). Two patients (7%) had nonfatal major complications (one non-ST-elevation myocardial infarction and one stroke).
ConclusionEarly graft failure generally presents as acute coronary syndrome. Graft occlusion/ thrombosis is the leading cause of ischaemia. Patients with graft failure can undergo PCI with a relatively low risk, but the need for redo CABG in associated with a high mortality. (Neth Heart J 2009;17:13-7.)

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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