Use of angioplasty in the management of complicated perioperative infarction following bypass surgery

Abstract

Ischemic complications in the perioperative period following bypass surgery adversely affect both short- and long-term prognosis. Coronary angioplasty was successfully performed in 2 patients sustaining complicated postoperative myocardial infarctions with resolution of angina and restoration of hemodynamic stability. These cases illustrate that angioplasty can be done safely in such patients and may favorably alter short-term outcome.

Coronary angioplasty to relieve a kinked venous bypass conduit

“…Angioplasty has been anecdotally reported in the early postoperative setting usually as a treatment for thrombotic occlusion of bypass grafts [9]. Generally, angioplasty is contraindicated during the immediate postoperative period because of concern for disrupting or dislodging sutures.…”

Clinical significance, angiographic characteristics, and short-term outcomes in 30 patients with early coronary artery graft failure

“…PCI for graft failure has yielded favourable results. [7][8][9][10][11][12][13][14] In a study of 45 patients, early angioplasty to relieve myocardial ischaemia was reported at a mean of 49 days after CABG; the intervention was successful in 95% of native artery lesions (n=46), and 100% of LIMA graft lesions (n=11). 8 Likewise, PCI with stenting of both the native arterial system and the coronary grafts has been successfully used to treat perioperative ischaemia.…”

“…2,6 In addition, percutaneous coronary intervention (PCI) has yielded excellent results in this setting. [7][8][9][10][11][12][13] With the recent changes in coronary surgery practice and advances in percutaneous coronary intervention (PCI), these complications may have different trends, features and outcomes. 3,4 The purpose of this study was to determine the incidence, clinical features, and angiographic characteristics of early graft failure in the present CABG era, and to assess the impact of procedural performance on short-term outcomes in patients undergoing PCI after early graft failure.…”

ACC/AHA/SCAI Practice Guidelines, February 21, 2006

“…Emergency PCI of a focal graft stenosis (venous or arterial) or recanalization of an acute graft thrombosis may successfully relieve ischemia in the majority of patients. Balloon dilatation across suture lines has been accomplished safely within days of surgery (526)(527)(528). Intracoronary fibrinolytic therapy should be administered with caution during the first week postoperatively (529)(530)(531)(532), and if required, residual thrombus may be "targeted" in low doses through a local drug delivery system.…”