Preoperative Intraaortic Balloon Pump Enhances Cardiac Performance and Improves the Outcome of Redo CABG☆
Section snippets
Patients and Methods
Between June 1, 1994, and October 1, 1996, 48 high-risk patients underwent redo CABG at our institution, having presented with at least two of the following additional criteria: poor left ventricular function (preoperative LVEF ≤ 0.40), unstable angina at the time of surgery (angina severity fluctuating between angina classes [Canadian Cardiovascular Society’s classification of angina] or angina at rest despite nitroglycerine infusion and calcium-channel inhibitors), left main stem stenosis
Operation Data
The average number of distal anastomoses was 3.5 ± 1.3 per patient (range, 1 to 6 distal anastomoses) in group 1 and 3.3 ± 1.3 per patient (range, 1 to 5 distal anastomoses) in group 2 (p = 0.472, not significant). The internal thoracic artery was used in 67% (16/24 patients) in group 1 and 63% (15/24 patients) in group 2 (p = 0.521, not significant). Coronary artery thromboendarterectomy was required in 8 patients in group 1 and 5 patients in group 2. The mean ischemia time did not differ between the
Comment
When compared with primary CABG, reoperative CABG is associated with an increased operative risk in terms of increased postoperative mortality and morbidity 1., 2., 3., 4.. Hospital mortality after redo CABG is independently influenced by infarct-borne left ventricular dysfunction [23], unstable angina at the time of the operation [4], and presence of a significant (≥70%) main stem stenosis of the left coronary artery [1], as well as a short interval between the primary and the redo operations
Discussion
DR CARY W. AKINS (Boston, MA): Maybe you can tell us about your techniques of myocardial preservation. One of the issues might be that if your reoperative patients had patent internal mammary grafts that you did not clamp, then the use of counterpulsation would help in perfusing those areas of the myocardium. Tell us about the incidence of arterial grafts that were patent in your redo patients and what your technique of myocardial preservation is.
DR CHRISTENSON: Regarding myocardial
Acknowledgement
This study was supported by a grant from St. Jude Medical AG, Basel, Switzerland. We are grateful to the perfusionists Jaenine Reuse and Bruno Nowicki.
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Presented at the Thirty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Feb 3–5, 1997.