Department of Orthopaedics and Traumatology, Jorvi Hospital, Espoo, Finland.
Scand J Surg. 2010;99(3):173-9. doi: 10.1177/145749691009900313.
early graft failure following coronary bypass surgery results in elevated morbidity and mortality. This study focused on the impact of angiographic graft evaluation.
of 5251 coronary artery bypass grafting (CABG) patients, 36 with postoperative persistent ischaemia underwent early angiography (23) or emergency resternotomy (13) 2000-2007 (Angiography era). Of the 23 patients, who underwent angiography, five were subsequently reoperated. Of 8807 CABG patients, 76 underwent postoperative emergency resternotomy 1988-1999 (Pre-angiography era) and served as controls.
the angiography era patients were older (64.0 years vs. 58.2 years, P = 0.002) and the proportion of female patients (22% vs. 43%, P = 0.029) was smaller. The rate of emergency reoperations decreased (0.86% vs 0.34%, P < 0.001) during the Angiography era and graft repairs (P = 0.013) or additional grafts (P = 0.006) were less frequent, although occluded anastomoses were observed more often (P = 0.043). In 5 Angiography era patients graft complications were corrected with percutaneous coronary intervention. ICU stay (5.72 + 0.98 days vs. 5.53 + 0.68 days) and hospital stay (12.2 + 1.54 days vs. 13.1 + 1.63 days) did not differ between the groups, but the rate of myocardial infarction (63.8% vs. 92.1%, P < 0.001) and in-hospital death (22.2% vs. 46.1%, P = 0.015) decreased.
after the introduction of early postoperative angiographic evaluation of CABG patients the rate of emergency reoperations and related morbidity and mortality decreased.
冠状动脉旁路移植术后早期移植物失败会导致发病率和死亡率升高。本研究侧重于血管造影评估的影响。
在 5251 例冠状动脉旁路移植术（CABG）患者中，36 例术后持续缺血的患者在 2000-2007 年（血管造影时代）行早期血管造影（23 例）或急诊开胸（13 例）。在接受血管造影的 23 例患者中，有 5 例随后再次手术。在 8807 例 CABG 患者中，76 例在 1988-1999 年（血管造影前时代）行术后急诊开胸术，并作为对照。
血管造影时代的患者年龄更大（64.0 岁 vs. 58.2 岁，P=0.002），女性患者比例更小（22% vs. 43%，P=0.029）。在血管造影时代，急诊再手术率降低（0.86% vs 0.34%，P<0.001），且进行了更少的搭桥修复术（P=0.013）或额外的搭桥术（P=0.006），尽管吻合口闭塞更为常见（P=0.043）。在 5 例血管造影时代的患者中，经皮冠状动脉介入治疗纠正了移植物并发症。两组患者 ICU 住院时间（5.72+0.98 天 vs. 5.53+0.68 天）和住院时间（12.2+1.54 天 vs. 13.1+1.63 天）无差异，但心肌梗死发生率（63.8% vs. 92.1%，P<0.001）和住院期间死亡率（22.2% vs. 46.1%，P=0.015）降低。
在引入冠状动脉旁路移植术后早期血管造影评估后，急诊再手术率以及相关发病率和死亡率降低。
