Surgical treatment of interventional coronary angiographic accidents

Newer methodologies have increased the incidence of coronary interventions. At the authors' institution, 5,614 coronary interventional procedures (28% of all catheterizations) were performed over a 3-year period, from 1995 to 1997. Eighty-one patients (1.4%) suffered angiographic accidents, includin g coronary artery dissection, free rupture, tamponade, foreign body embolis m, and wire entrapment, and were retrospectively reviewed. All patients wer e taken for emergency surgery in less than 4 hours. The mean age was 61.2 y ears, 44 (54%) were men, and 37 (46%) were in cardiogenic shock at the time of surgery. Fifty-seven patients (70%) had intraaortic balloon counterpuls ation. The number of previous cardiac interventions ranged from one to four with a mean of 1.9. One to five bypass grafts (mean, 2.2) were performed, and three patients required temporary ventricular assist devices. There wer e six deaths for a 30-day mortality rate of 7.4%. Thirty-two patients (39.5 %) suffered significant morbidity, including cerebrovascular accidents, and renal and respiratory failure. Perioperative myocardial infarctions were d iagnosed in 39 (48%) patients. Average length of stay was 12.1 days. One-ye ar survival was satisfactory at 90% (73/81), with 56 survivors (77%) regain ing normal everyday activity. Early surgical intervention, rapid revascular ization, and temporary mechanical support are keys to low mortality in this high-risk group. Identification of high-risk interventions and significant comorbid conditions, with concomitant surgical consultation, need to be pu rsued to reduce the high morbidity rate.