European Journal of Cardio-Thoracic Surgery, Vol 3, 549-553, Copyright © 1989 by European Association for Cardio-thoracic Surgery
Emergency surgical revascularization following coronary angioplasty: evaluation of operative results by isoenzyme analysis and electrocardiography
U Hake, S Iversen, HG Jakob, A Neufang, R Erbel, T Pop, J Meyer and H Oelert
Division of Cardiothoracic and Vascular Surgery, Johannes Gutenberg University, Mainz, FRG.
Seventeen patients underwent emergency coronary artery bypass grafting due
to balloon catheter induced occlusion or dissection of a major coronary
artery. Patients were revascularized within a maximum of 210 min from the
onset of ischaemia and received an average of 1.6 distal anastomoses. A
perioperative transmural or non-transmural myocardial infarction as
diagnosed by CK-MB activity and electrocardiographic patterns occurred in 7
patients (41.2%). One early death resulted in an overall perioperative
mortality of 5.9%. Successful preservation of myocardium was demonstrated
in 10 patients by a rapid decline of CK-MB activity, no perioperative
electrocardiographic changes and no requirement for inotropic support. The
incidence of a perioperative myocardial infarction was independent of the
anginal status before coronary angioplasty or the angiographic evidence of
a complete occlusion versus a dissection. Major ischaemic myocardial
complications associated with coronary angioplasty are rare but frequently
catastrophic events. Fast surgical intervention is mandatory to prevent
myocardial infarction or to limit the extent of injury. The operative
outcome can be evaluated by careful analysis of time release curves and
cumulative parameters of CK-MB activity.
