INTERVENTIONAL STANDBY FOR CARDIAC-SURGERY

Life threatening Q-infarction because of bypassgraft occlusion may occ urr in 5-8 % of the patients during the first days after CABG, and mos t patients are treated by immediate reoperation. This treatment may ho wever be delayed because operating rooms might not be available immedi ately. We prospectively studied the feasability and safety of immediat e coronary angiography and PTCA, if appropriate, in patients with seve re ischemic in-hospital complications after CABG. From January till De cember 1995 1263 patients had CABG: mean age 64.9 +/- 10 y, 24 % femal e, 7.1 % emergencies (CABG < 24 h after coronary angiography). A 24 ho urs interventional standby was provided to perform immediate catheteri zation and PTCA in patients with signs of evolving myocardial infarcti on after CABG (ST-elevation in greater than or equal to 2 leads and he modynamic compromise or new LV hypocinesia in the transoesophageal ech ocardiogramm). Results: 3/1263 patients had immediate reoperation with out angiography. 55/1263 patients were catheterized, all within 1 hour after the onset of St-elevation. 14/1263 had normal grafts and comple te revascularization. Their ischemia was either transient (spasm) or t he ECG was misinterpreted (pericarditis). Catheterization caused no se vere complications. 2 patients had major bleeding at the puncture site . 41 patients presented with envolving Q-MI: 1 patient had immediate r eoperation, 29 patients received immediate PTCA and 11 patients were t reated medically. 8/29 PTCA-patients were in cardiogenic shock. We dil ated 4 IMA-anastomoses, 3 distal veingraft anastomoses, 18 native vess els with occluded veingrafts and 4 native vessels, having not been gra fted. Angiographic success was achieved in 20/29 (69 %), clinical succ ess in 65 % (residual stenosis < 50 %, no severe complications during hospital stay). 2 patients died during the first 30 days (none due to the PTCA procedure or PTCA-related delay of reoperation), Q-MI occurre d in 2/29, NonQ-MI in 7/29, reoperation appeared necessary in 4/29, no bleeding complications were noticed. Conclusions: Immediate coronary angiography after CABG is feasable and safe. Salvage-PTCA early after CABG is an alternative treatment in patients with evolving Q-MI. Inter ventional standby might therefore be useful for institutions with a bu sy cardiac surgical program.