Risk analysis of operative intervention for failed coronary angioplasty

Emergency bypass surgery for failed coronary interventions

“…Full cardiopulmonary bypass support can be easily instituted if necessary. Comparing these patients to elective bypass patients Borkon et al [20] found no significant difference in operative characteristics between these two groups, including aortic cross-clamp time, bypass time, and number of grafts used. However, postoperative need for inotropes and intra-aortic balloon pump was significantly higher in the emergency surgery group.…”

“…Nevertheless, recent data suggest that leaving a perfusion balloon catheter at the lesion's site is not associated with improved clinical outcome, mortality, or incidence of myocardial infarction [20]. Indeed, despite the success of this modality in management of certain cases of acute closure and significant ischemia, it may actually foster a false sense of security and thus delay surgical reperfusion.…”

“…Reverse saphenous vein grafts are the preferred conduit as their utilization minimizes revascularization time [20]. This time frame is crucial since ischemic status, upon arrival to the operation room, is a strong predictor of periprocedural myocardial infarction [28].…”

“…An area of dissection is treated by either direct anastomosis and tacking down of the intimal flap, or end-to-end anastomosis in an area beyond the dissection. Complete revascularization is recommended [20].…”

III Diretriz sobre tratamento do infarto agudo do miocárdio

“…No entanto, esses casos apresentam alta mortalidade, cujo risco se eleva na presença de choque cardiogê-nico, tempo de isquemia superior a 4h, doença multiarterial e revascularização cirúrgica prévia 482,483 .…”