Significance and management of early graft failure after coronary artery bypass grafting - Feasibility and results of acute angiography and re-re-vascularization
Significance and management of early graft failure after coronary artery bypass grafting - Feasibility and results of acute angiography and re-re-vascularization
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DOI：
10.1016/s1010-7940(97)00268-6
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发表时间：
1997-12-01
影响因子：
3.4
通讯作者：
Pettersson, G
中科院分区：
文献类型：
--
作者：
Rasmussen, C;Thiis, JJ;Pettersson, G
冠脉搭桥术后围手术期的缺血和梗塞与增加的发病率和死亡率有关。目的：通过急性血管再造影术探讨围手术期脑缺血和脑梗塞的原因，并对移植物失败或其他原因引起的不完全再血管化进行治疗。方法：1990-1995年间，2003例患者接受了一次单独的冠状动脉搭桥术。如果出现以下一项或多项标准，则怀疑心肌缺血：心电图ST段新改变；CKMB值大于80U/L；胃电出现新的Q波；反复发作或持续室性快速性心律失常；室颤；血流动力学恶化和左心衰。对病情稳定的患者进行急性冠状动脉造影术，而血流动力学严重受损的患者则被紧急送往手术室。结果：在所有CABG中，共有71例(3.5%)疑似移植物衰竭的患者被确定并纳入研究。根据患者是否进行了急性再血管造影术(n=59；组1)或立即再手术(n=12；组2)进行分组。在第1组，急性再血管造影显示43例(73%)移植血管失败/不完全再血管化。冠状动脉造影发现：S静脉桥闭塞19例(32%)，冠状动脉远端吻合不良10例(17%)，乳内动脉狭窄4例(7%)，乳内动脉闭塞3例(5%)，静脉桥狭窄3例(5%)，左乳动脉锁骨下动脉盗血2例(3%)，冠状动脉搭桥错误1例(2%)。根据血管造影结果，27例患者进行了再次手术和再次移植。在再次手术时，18名患者(67%)有心电图或CKMB记录的进展性脑梗塞。2名患者(3%)发生了与再次血管造影术直接相关的中风。30d死亡率为3例(7%)。在第2组中，11例(92%)出现移植物闭塞。30天死亡率为6例(50%)。结论：冠状动脉旁路移植术后早期，急性血管再造影术显示大多数心肌缺血患者移植物失败或血管重建不完全。再次手术进行再血管重建术风险较低。很少有循环衰竭的患者可以在没有事先血管造影术的情况下立即再次手术来挽救。(C)1997年爱思唯尔科学公司。
Perioperative ischaemia and infarction after CABG are associated with increased morbidity and mortality. Objective: To study causes of perioperative ischaemia and infarction by acute re-angiography and to treat incomplete re-vascularization caused by graft failure or any other cause. Methods: Between 1990 and 1995, 2003 patients underwent an isolated CABG operation. Myocardial ischaemia was suspected if one or more of the following criteria were present: New changes in the ST-segment in the ECG; a CKMB value greater than 80 U/L; new Q-waves in the EGG; recurrent episodes of, or sustained ventricular tachyarrhythmia; ventricular fibrillation; haemodynamic deterioration and left ventricular failure. Acute coronary angiography was performed in stable patients, while haemodynamically severely compromised patients were rushed to the operating room. Results: A total of 71 (3.5%) patients of all CABGs with suspected graft failure were identified and included in the study. Patients were grouped according to whether they had an acute re-angiography (n = 59; group 1) or an immediate re-operation (n = 12; group 2) performed. In group 1, the acute re-angiography demonstrated graft failure/incomplete re-vascularization in 43 patients (73%). The angiographic findings were: Occluded vein graft(s) in 19 (32%); poor distal run-on to the grafted coronary artery in ten (17%); internal mammary artery stenosis in four (7%); internal mammary artery occlusion in three (5%); vein graft stenoses in three (5%); left mammary artery subclavian artery steal in two (3%); and the wrong coronary artery grafted in one (2%). Based on the angiography findings, 27 patients were re-operated and re-grafted. At the time of re-operation, 18 patients (67%) had evolving infarction documented by ECG or CKMB. Two patients (3%) experienced stroke in immediate relation to the re-angiography. The 30-day mortality was three (7%). In group 2, graft occlusions were found in 11 patients (92%). The 30-day mortality was six (50%). Conclusion: An acute re-angiography demonstrated graft failure or incomplete re-vascularization in the majority of patients with myocardial ischaemia early after CABG. Re-operation for re-re-vascularization was performed with low risk. Few patients with circulatory collapse could be saved by an immediate re-operation without preceding angiography. (C) 1997 Elsevier Science B.V.