This study was done to assess the results surgery for coronary artery bypass grafting (CABG) after complicated cardiac catheterization and interventional procedures at Queen Alia Heart Institute (QAHI)-King Hussein Medical Centre (KHMC). Between January 1995 and December 2000, eighty nine patients underwent emergency coronary bypass surgery following either diagnostic or interventional coronary angiography. The following variables were obtained from the medical records. Patients characteristics, mode of presentation, extent and severity of coronary artery disease, preoperative clinical and hemodynamic status, preoperative left ventricular function, previous CABG surgery, types of constructed conduits and associated procedures, use of intraoretic balloon pump (IABP), operative outcome and in hospital major cardiac events. Follow up was obtained on all surviving patients. Emergency CABG patients tented to be males (79.9%) more symptomatic (66.4% in class III and IV) and harboring more left main coronary disease (30%). The overall hospital mortality rate was high (13.3%) compared to the low rate of (4.5%) in our elective CABG population. Internal mammary artery (IMA) grafts were used less frequently (36.6%) compared to (93%) in our CABG population. Ten patients (11.2%) had additional cardiac procedures. A mean follow up duration of 31 months was available on all surviving 79 and (83%) were completely asymptomatic.

Eighty-five patients underwent myocardial revascularization using artery grafts alone and were followed up for 30 months. Twenty-seven patients (31.7%) had single vessel disease, 28 patients (32.94%) had two-vessel disease and 30 patients (35.3%) had three or more obstructed coronary arteries. Eight of the patients had undergone previous surgical revascularization. The left internal mammary artery (LIMA) was routinely used for the left anterior descending branch (LAD). In 8 patients (9.4%), the in situ right internal mammary artery (RIMA) was used for revascularization of the right coronary artery (RCA) and its branches. The RIMA was sometimes used as a free graft from the aorta or as an artificial "Y" from the LIMA to the diagonal and marginal branches. We used the left radial artery (RA) as arterial conduit in 51 patients (60%). There were 2 intraoperative deaths. Hospital mortality was 9% (n=8). Of the fatal cases, 3 were redo surgeries, 3 underwent combined procedures (one for left ventricular aneyrysm, one for double valve replacement and one for mitral valve replacement) while only 3 of the fatal cases underwent revascularization as a primary and isolated procedure. It is concluded that complete arterial reconstruction carries an acceptably low operative mortality and excellent short-term follow-up. This strategy is particularly important for young patients to reduce the probability of future reoperation.