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Coronary artery disease
Original research article
Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery
  1. Davorin Sef1,
  2. Janko Szavits-Nossan2,3,
  3. Mladen Predrijevac3,4,
  4. Rajna Golubic5,
  5. Tomislav Sipic2,3,
  6. Kresimir Stambuk2,3,
  7. zvonimir korda4,
  8. Pascal Meier6,7 and
  9. Marko Ivan turina8
  1. 1 Harefield Hospital, Harefield, UK
  2. 2 Department of Cardiology, Magdalena – Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
  3. 3 J.J. Strossmayer University, Osijek, Croatia
  4. 4 Department of Cardiovascular Surgery, Magdalena – Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
  5. 5 Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
  6. 6 Royal Brompton and Harefield NHS Foundation Trust, London, London, UK
  7. 7 Kantonsspital Graubunden, Chur, GR, Switzerland
  8. 8 Universitat Zurich, Zurich, ZH, Switzerland
  1. Correspondence to Dr Davorin Sef; davorin.sef{at}gmail.com

Abstract

Objectives Updated knowledge about perioperative myocardial ischaemia (MI) after coronary artery bypass grafting (CABG) and treatment of acute graft failure is needed. We analysed main factors associated with perioperative MI and effects of immediate coronary angiography-based treatment strategy on patient outcome.

Methods Among 1119 consecutive patients with coronary artery disease who underwent isolated CABG between January 2011 and December 2015, 43 (3.8%) patients underwent urgent coronary angiography due to suspected perioperative MI. All the data were prospectively collected and retrospectively analysed. The primary endpoint was 30-day mortality; postoperative left ventricular ejection fraction) and major adverse cardiac events were secondary endpoints.

Results

Overall, 30-day mortality in patients with CABG was 1.4% while in patients who developed perioperative MI was 9% (4 patients). Angiographic findings included incorrect graft anastomosis, graft spasm, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularisation. Emergency reoperation (Redo) was performed in 14 (32%), acute percutaneous coronary intervention (PCI) in 15 (36%) and conservative treatment (Non-op) in 14 patients. Demographic and preoperative clinical characteristics between the groups were comparable. Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs 53% pre-op) and did not change in groups PCI (56% post-op vs 57% pre-op) and Non-op (58% post-op vs 57% pre-op).

Conclusions Urgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. Urgent PCI may be associated with improved clinical outcome in patients with early graft failure.

  • coronary artery bypass graft
  • myocardial ischaemia and infarction (ihd)
  • early graft failure
  • re-intervention
  • coronary angiography

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/openhrt-2019-001027

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    Footnotes

    • Contributors The authors of the paper take full responsibility.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethics Committee of Magdalena - Clinic for Cardiovascular Diseases.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available in a public, open access repository.