[Emergency and subemergency coronary artery bypass graft: active use of arterial grafts].

Fifty-nine patients underwent emergency or subemergency coronary artery bypass grafting (CABG) from June 1996 to February 1999. The patients were divided into two groups, namely an emergency group (13 patients) and subemergency group. The patients in the emergency group were operated on within 24 hours of diagnosis and those in the subemergency group were operated immediately after 24 hours of diagnosis. In the emergency group, two patients required cardiac resuscitation before operation because of a cardiogenic shock. Eleven patients of the emergency group required intra-aortic balloon pumping (IABP) before operation. Eleven patients operated for mediansternotomy with a cardiopulmonary bypass and remaining two patients for minimally invasive direct coronary artery bypass grafting (MIDCAB). The ratio of arterial grafts was 52% in the emergency group (8 LITA, 7 Radial artery, 1 RGEA). Four of the 13 patients used only SVG. There was one each of the operative and hospital death. On the post operative angiography of the grafts, arterial graft were all patent. In the subemergency group, 38 of 46 patients underwent conventional CABG with median sternotomy using a cardiopulmonary bypass. MIDCAB was indicated in eight patients. Thirty-one patients had a bypass formed with only arterial grafts, 84.7% of whom used arterial grafts. On the postoperative angiography, LITA, RGEA, and IEA were all patent and the radial artery was occluded in one anastmosis (96%). Only one patients died of mediastinitis 25 days after operation. In both groups CABG using arterial grafts can be done even with IABP inserted if the preoperative condition is stable. This will help improve late prognosis.