Is it better to treat bypass graft or native coronary artery following early graft failure?

Abstract

Several studies have already shown that coronary angiography and PCI can be safely performed after CABG. It is of paramount importance that early graft failure is recognized in a timely manner and that an appropriate treatment is delivered immediately in order to reduce the extent of myocardial damage and improve clinical outcome. Therefore, urgent angiography allows both identification of the underlying cause of early graft failure and immediate treatment according to the findings. So far, recent evidence shows that PCI to native coronary arteries is associated with higher procedural success rate and less complications leading to the better clinical outcome.

Postcardiac surgery myocardial ischemia: Why, when, and how to intervene

“…4,52,54 Conservative treatment may be indicated if angiography has excluded any mechanical or other overtly treatable cause. 49,55 Conservative treatment should be considered in patients who have a patent graft in the setting of PMI or in cases where baseline myocardial viability is already known to be limited. 50 Mechanical circulatory support should only be used as an adjunct rather than as a primary treatment.…”

“…Intra-aortic balloon pump or peripheral extracorporeal membrane oxygenation can be considered in rescuing patients who develop significant hemodynamic instability before transfer to the OR or catheterization laboratory, or in the case of hemodynamic instability despite proven patent grafts and maximum inotropic support. 55 Irrespective of the strategy used, expeditious treatment is of paramount importance to minimize myocardial damage and to improve clinical outcomes. 8,13 Karhunen and colleagues 12 have reported that in comparison with patients with PMI who did not undergo repeat angiography, angiography was associated with a significant decrease in inhospital mortality (22% vs 46%, P ¼ .015) and a lower rate of emergency CABG reoperations.…”