Fleißner Felix, Issam Ismail, Martens Andreas, Cebotari Serghei, Haverich Axel, Shrestha Malakh Lal
Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Thorac Cardiovasc Surg. 2017 Jun;65(4):292-295. doi: 10.1055/s-0035-1564927. Epub 2015 Oct 30.
Coronary artery bypass grafting (CABG) is the "gold standard" for patients with multiple vessel coronary artery disease (CAD). However, there is no "gold standard" to control bypass patency immediately postoperatively. "Post-completion" control angiogram (CA) is not routinely performed. We retrospectively analyzed the data of all patients undergoing urgent coronary angiogram post-CABG at our center. Between January 2005 and June 2011, a total of 6,025 patients underwent CABG (isolated or combined) for CAD in our hospital. In patients who underwent urgent postoperative CA, high serum cardiac enzymes (>100 CK-MB), severe new ECG changes, or unexpected low left ventricular function were present. A total of 106 patients (1.8%) underwent post-CABG urgent coronary angiogram. Overall 30-day mortality in this cohort was 8.5%. The average time between the cardiac operation and the coronary angiogram in these patients was 3.41 ± 5.68 days. The rates for an urgent coronary angiogram were 1.3% ( = 25), 2% ( = 65), and 1.8% ( = 16) for total arterial, combined arterial, and venous and solely venous CABG, respectively. Twenty-four percent of patients underwent CABG bypass revision, while 32% of the patients underwent PTCA, stenting, or both. Younger patients, female patients, smaller patients, and patients receiving a combined arterial and venous revascularization were at a higher risk for an unplanned postoperative CA in the multivariate risk analysis. This study shows that the necessity for urgent post-CABG coronary angiogram is low (1.8%). However, more than half of the patients undergoing postoperative coronary angiogram needed reintervention, and, in spite of it, had high mortality. "Completion" control angiogram is not always feasible, patients at higher risk (e.g., female patients) should be identified and post-CABG coronary angiogram performed as soon as possible without undue delay, or a primary hybrid approach with an intraoperative CA should be applied.
冠状动脉旁路移植术（CABG）是多支血管冠状动脉疾病（CAD）患者的“金标准”。然而，术后即刻控制搭桥血管通畅性尚无“金标准”。“完成后”控制血管造影（CA）并非常规进行。我们回顾性分析了在我们中心接受CABG术后紧急冠状动脉造影的所有患者的数据。2005年1月至2011年6月期间，我院共有6025例患者因CAD接受了CABG（单独或联合）手术。接受术后紧急CA的患者存在高血清心肌酶（>100 CK-MB）、严重的新心电图改变或意外的左心室功能低下。共有106例患者（1.8%）接受了CABG术后紧急冠状动脉造影。该队列的总体30天死亡率为8.5%。这些患者心脏手术与冠状动脉造影之间的平均时间为3.41±5.68天。全动脉、联合动脉以及静脉和单纯静脉CABG的紧急冠状动脉造影率分别为1.3%（n = 25）、2%（n = 65）和1.8%（n = 16）。24%的患者接受了CABG搭桥术修订，而32%的患者接受了PTCA、支架置入术或两者。在多因素风险分析中，年轻患者、女性患者、体型较小的患者以及接受动脉和静脉联合血运重建的患者术后计划外CA的风险较高。本研究表明，CABG术后紧急冠状动脉造影的必要性较低（1.8%）。然而，超过一半接受术后冠状动脉造影的患者需要再次干预，尽管如此，死亡率仍很高。“完成后”控制血管造影并不总是可行的，应识别出高风险患者（如女性患者），并在不无故延迟的情况下尽快进行CABG术后冠状动脉造影，或采用术中CA的原发性杂交方法。
