Emergency Coronary Artery Bypass Grafting for the Treatment of Coronary Accidents during Percutaneous Coronary Intervention_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TANGMin ,  MEIJu , BAOChun-rong , LIUHao , ZHANGJun-wen

Department of Cardiothoracic Surgery, Xinhua Hospital, Medical School of Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding author：

MEIJu, Email: ju_mei63@126.com

Keywords：

Percutaneous coronary intervention; Coronary accident; Coronary artery bypass grafting

DOI：

10.7507/1007-4848.20150005

Video：

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Objective To summarize our experience of emergency coronary artery bypass grafting (CABG) for the treatment of coronary accidents during percutaneous coronary intervention (PCI). Methods From January 2011 to January 2013, 30 patients with coronary accidents during PCI from our hospital and other hospitals received surgical treatment in Xinhua Hospital, Medical School of Shanghai Jiaotong University. There were 21 male and 9 female patients with their age of 68±11 (54-84) years. Coronary accidents included coronary artery dissection in 12 patients, coronary artery perforation in 12 patients, acute in-stent thrombosis in 2 patients, dilation balloon rupture in 1 patient and balloon retention in 1 patient, and PCI guidewire retention in 2 patients. Among the 30 patients, 8 patients received intra-aortic balloon pump (IABP) implantation preoperatively. All the patients underwent emergency CABG, including 29 patients undergoing off-pump CABG and 1 patient undergoing CABG on pump with heart beating. The patients' medical history, PCI and surgical records were retrospectively reviewed, and surgical treatment strategies, clinical outcomes and prognosis were summarized. Results The average number of grafts was 2.8±0.4. Postoperative length of ICU stay was 8.3±4.8 days, and mean hospital stay was 20.3±15.2 days. Postoperative complications included low cardiac output syndrome (LCOS) in 3 patients, tracheotomy in 2 patients, acute renal failure requiring continuous renal replacement therapy in 2 patients, and reexploration for bleeding in 1 patient. Twenty-eight were discharged, 1 patient died of multiple organ dysfunction syndrome caused by LCOS, and another patient died of refractory ventricular fibrillation. A total of 26 patients were followed up for 10.2±8.3 months and 1 patient died of stroke during the following up. Conclusion Emergency CABG can restore coronary artery blood flow quickly and provide good results for coronary accidents during PCI.

Citation： TANGMin, MEIJu, BAOChun-rong, LIUHao, ZHANGJun-wen. Emergency Coronary Artery Bypass Grafting for the Treatment of Coronary Accidents during Percutaneous Coronary Intervention. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 19-22. doi: 10.7507/1007-4848.20150005 Copy

1.	Stathopoulos I, Kossidas K, Panagopoulos G, et al. Cardiac tamponade complicating coronary perforation during angioplasty:short-term outcomes and long-term survival. J Invasive Cardiol, 2013, 25(10):486-491.
2.	Seshadri N, Whitlow PL, Acharya N, et al. Emergency coronary artery bypass surgery in the contemporary percutaneous coronary intervention era. Circulation, 2002, 106(18):2346-2350.
3.	Hendry C, Fraser D, Eichhofer J, et al. Coronary perforation in the drug-eluting stent era:incidence, risk factors, management and outcome:the UK experience. EuroIntervention, 2012, 8(1):79-86.
4.	Rogers JH, Lasala JM. Coronary artery dissection and perforation complicating percutaneous coronary intervention. J Invasive Cardiol, 2004, 16(9):493-499.
5.	Darwazah AK, Islim I, Hanbali B, et al. Emergency coronary artery bypass surgery after failed percutaneous coronary intervention. J Cardiovasc Surg (Torino), 2009, 50(6):795-800.
6.	Schrale RG, van Gaal W, Channon KM, et al. Long-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery disease. Int J Cardiol, 2008, 130(2):185-189.
7.	Koskinas KC, Chatzizisis YS, Antoniadis AP, et al. Role of endothelial shear stress in stent restenosis and thrombosis:pathophysiologic mechanisms and implications for clinical translation. J Am Coll Cardiol, 2012, 59(15):1337-1349.
8.	Gruntzig AR, Senning A, Siegenthaler WE. Nonoperative dilatation of coronary-artery stenosis:percutaneous transluminal coronary angioplasty. N Engl J Med, 1979, 301(2):61-68.
9.	De Luca G. Glycoprotein Ⅱb-Ⅲa inhibitors. Cardiovasc Ther, 2012, 30(5):e242-e254.
10.	Valgimigli M, Tebaldi M, Borghesi M, et al. Two-year outcomes after first- or second-generation drug-eluting or bare-metal dtent implantation in all-comer patients undergoing percutaneous coronary intervention:a pre-specified analysis from the PRODIGY study (PROlonging dual antiplatelet treatment after grading stentinduced intimal hyperplasia study). JACC Cardiovasc Interv, 2014, 7(1):20-28.
11.	Ellis SG, Weintraub W, Holmes D, et al. Relation of operator volume and experience to procedural outcome of percutaneous coronary revascularization at hospitals with high interventional volumes. Circulation, 1997, 95(11):2479-2484.
12.	Stolker JM, Allen DS, Cohen DJ, et al. Comparison of procedural complications with versus without interventional cardiology fellows-in-training during contemporary percutaneous coronary intervention. Am J Cardiol, 2014, 113(1):44-48.
13.	Roy P, de Labriolle A, Hanna N, et al. Requirement for emergent coronary artery bypass surgery following percutaneous coronary intervention in the stent era. Am J Cardiol, 2009, 103(7):950-953.
14.	吕树铮, 宋现涛, 陈韵岱, 等. 中国内地2005 年度经皮冠状动脉介入治疗登记调查研究结果初步分析. 中华心血管病杂志, 2006, 34(11):966-970.
15.	Jaffe R, Strauss BH. Late and very late thrombosis of drug-eluting stents:evolving concepts and perspectives. J Am Coll Cardiol, 2007, 50(2):119-127.
16.	McEntegart MB, Kirtane AJ, Cristea E, et al. Intraprocedural thrombotic events during percutaneous coronary intervention in Patients with non-ST-segment elevation acute coronary syndromes are associated with adverse outcomes. Analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol, 2012, 59(20):1745-1751.
17.	Rezkalla SH, Kloner RA. Coronary no-reflow phenomenon:from the experimental laboratory to the cardiac catheterization laboratory. Catheter Cardiovasc Interv, 2008, 72(7):950-957.
18.	Muller O, Trana C, Eeckhout E. Myocardial no-reflow treatment. Curr Vasc Pharmacol, 2013, 11(2):278-285.
19.	Srikanth S, Ambrose JA. Pathophysiology of coronary thrombus formation and adverse consequences of thrombus during PCI. Curr Cardiol Rev, 2012, 8(3):168-176.
20.	Kiernan TJ, Yan BP, Ruggiero N, et al. Coronary artery perforations in the contemporary interventional era. J Interv Cardiol, 2009, 22(4):350-353.

1. Stathopoulos I, Kossidas K, Panagopoulos G, et al. Cardiac tamponade complicating coronary perforation during angioplasty:short-term outcomes and long-term survival. J Invasive Cardiol, 2013, 25(10):486-491.
2. Seshadri N, Whitlow PL, Acharya N, et al. Emergency coronary artery bypass surgery in the contemporary percutaneous coronary intervention era. Circulation, 2002, 106(18):2346-2350.
3. Hendry C, Fraser D, Eichhofer J, et al. Coronary perforation in the drug-eluting stent era:incidence, risk factors, management and outcome:the UK experience. EuroIntervention, 2012, 8(1):79-86.
4. Rogers JH, Lasala JM. Coronary artery dissection and perforation complicating percutaneous coronary intervention. J Invasive Cardiol, 2004, 16(9):493-499.
5. Darwazah AK, Islim I, Hanbali B, et al. Emergency coronary artery bypass surgery after failed percutaneous coronary intervention. J Cardiovasc Surg (Torino), 2009, 50(6):795-800.
6. Schrale RG, van Gaal W, Channon KM, et al. Long-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery disease. Int J Cardiol, 2008, 130(2):185-189.
7. Koskinas KC, Chatzizisis YS, Antoniadis AP, et al. Role of endothelial shear stress in stent restenosis and thrombosis:pathophysiologic mechanisms and implications for clinical translation. J Am Coll Cardiol, 2012, 59(15):1337-1349.
8. Gruntzig AR, Senning A, Siegenthaler WE. Nonoperative dilatation of coronary-artery stenosis:percutaneous transluminal coronary angioplasty. N Engl J Med, 1979, 301(2):61-68.
9. De Luca G. Glycoprotein Ⅱb-Ⅲa inhibitors. Cardiovasc Ther, 2012, 30(5):e242-e254.
10. Valgimigli M, Tebaldi M, Borghesi M, et al. Two-year outcomes after first- or second-generation drug-eluting or bare-metal dtent implantation in all-comer patients undergoing percutaneous coronary intervention:a pre-specified analysis from the PRODIGY study (PROlonging dual antiplatelet treatment after grading stentinduced intimal hyperplasia study). JACC Cardiovasc Interv, 2014, 7(1):20-28.
11. Ellis SG, Weintraub W, Holmes D, et al. Relation of operator volume and experience to procedural outcome of percutaneous coronary revascularization at hospitals with high interventional volumes. Circulation, 1997, 95(11):2479-2484.
12. Stolker JM, Allen DS, Cohen DJ, et al. Comparison of procedural complications with versus without interventional cardiology fellows-in-training during contemporary percutaneous coronary intervention. Am J Cardiol, 2014, 113(1):44-48.
13. Roy P, de Labriolle A, Hanna N, et al. Requirement for emergent coronary artery bypass surgery following percutaneous coronary intervention in the stent era. Am J Cardiol, 2009, 103(7):950-953.
14. 吕树铮, 宋现涛, 陈韵岱, 等. 中国内地2005 年度经皮冠状动脉介入治疗登记调查研究结果初步分析. 中华心血管病杂志, 2006, 34(11):966-970.
15. Jaffe R, Strauss BH. Late and very late thrombosis of drug-eluting stents:evolving concepts and perspectives. J Am Coll Cardiol, 2007, 50(2):119-127.
16. McEntegart MB, Kirtane AJ, Cristea E, et al. Intraprocedural thrombotic events during percutaneous coronary intervention in Patients with non-ST-segment elevation acute coronary syndromes are associated with adverse outcomes. Analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol, 2012, 59(20):1745-1751.
17. Rezkalla SH, Kloner RA. Coronary no-reflow phenomenon:from the experimental laboratory to the cardiac catheterization laboratory. Catheter Cardiovasc Interv, 2008, 72(7):950-957.
18. Muller O, Trana C, Eeckhout E. Myocardial no-reflow treatment. Curr Vasc Pharmacol, 2013, 11(2):278-285.
19. Srikanth S, Ambrose JA. Pathophysiology of coronary thrombus formation and adverse consequences of thrombus during PCI. Curr Cardiol Rev, 2012, 8(3):168-176.
20. Kiernan TJ, Yan BP, Ruggiero N, et al. Coronary artery perforations in the contemporary interventional era. J Interv Cardiol, 2009, 22(4):350-353.

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Emergency Coronary Artery Bypass Grafting for the Treatment of Coronary Accidents during Percutaneous Coronary Intervention

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