Outcome in Patients Having Salvage Coronary Artery Bypass Grafting

被引:24
作者
Santarpino, Giuseppe [1 ]
Ruggieri, Vito G. [2 ]
Mariscalco, Giovanni [3 ]
Bounader, Karl [2 ]
Beghi, Cesare [4 ]
Fischlein, Theodor [1 ]
Onorati, Francesco [5 ]
Faggian, Giuseppe [5 ]
Gatti, Giuseppe [6 ]
Pappalardo, Aniello [6 ]
De Feo, Marisa [7 ]
Bancone, Ciro [7 ]
Perrotti, Andrea [8 ]
Chocron, Sidney [8 ]
Dalen, Magnus [9 ,10 ]
Svenarud, Peter [9 ,10 ]
Rubino, Antonino S. [11 ]
Mignosa, Carmelo [11 ]
Gherli, Riccardo [12 ]
Musumeci, Francesco [12 ]
Dell'Aquila, Angelo M. [13 ]
Kinnunen, Eeva-Maija [14 ]
Biancari, Fausto [14 ]
机构
[1] Paracelsus Med Univ Nuremberg, Dept Cardiac Surg, Nurnberg, Germany
[2] Univ Hosp Pontchaillou, Dept Thorac & Cardiovasc Surg, Rennes, France
[3] Univ Leicester, Glenfield Hosp, Cardiac Surg, Leicester, Leics, England
[4] Osped Circolo Varese, Cardiac Surg Unit, Dept Heart & Vessels, Varese, Italy
[5] Univ Verona, Div Cardiac Surg, I-37100 Verona, Italy
[6] Osped Riuniti, Div Cardiac Surg, Trieste, Italy
[7] V Monaldi Hosp, Dept Cardiothorac & Resp Sci, Naples, Italy
[8] Univ Hosp Jean Minjoz, Dept Thorac & Cardiovasc Surg, Besancon, France
[9] Karolinska Univ Hosp, Dept Cardiothorac Surg & Anesthesia, Stockholm, Sweden
[10] Karolinska Univ Hosp, Dept Mol Med & Surg, Stockholm, Sweden
[11] Univ Catania, Cardiac Surg Unit, AOU Policlin Vittorio Emanuele, Catania, Italy
[12] San Camillo Hosp, Dept Cardiac Surg, Rome, Italy
[13] Univ Hosp Munster, Dept Cardiac Surg, Munster, Germany
[14] Univ Oulu, Dept Surg, Oulu, Finland
关键词
EXTRACORPOREAL MEMBRANE-OXYGENATION; ACUTE MYOCARDIAL-INFARCTION; CARDIOGENIC-SHOCK; INTERVENTION; RESCUE;
D O I
10.1016/j.amjcard.2015.07.034
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Salvage coronary artery bypass grafting (CABG) is often performed for cardiogenic shock on compassionate basis without clinical data justifying this aggressive approach. The aim of this study was to analyze early and intermediate outcomes after salvage CABG. We retrospectively reviewed the data of 85 patients who underwent salvage CABG at 11 European cardiac surgery centers. Salvage CABG was defined according to the EuroSCORE criteria, that is, a procedure performed in patients requiring cardiopulmonary resuscitation (external cardiac massage) en route to the operating theater or before induction of anesthesia. A percutaneous coronary intervention procedure preceded salvage CABG in 55 patients (64.7%). Thirty patients (35.3%) died during the inhospital stay. The mean EuroSCORE II was 32.0% and the observed-to-expected ratio was 1.08. Salvage CABG was associated with high rates of postoperative stroke (9.4%), restemotomy for bleeding (23.5%), restemotomy for hemodynamic instability (15.3%), dialysis (18.8%), severe gastrointestinal complications (12.9%), and deep sternal wound infection (10.6%). Survival at 1, 3, and 5 years was 58.6%, 49.8%, and 40.9%, respectively. Twenty patients (23.5%) were postoperatively treated with extracorporeal membrane oxygenation (ECMO). The rates of adverse events after ECM were particularly high (stroke 40%, resternotomy for bleeding 60%, dialysis 35%, gastrointestinal complications 30%, and deep sternal wound infection 30%). Of patients treated with ECMO, 8 (40%) survived to discharge, and 1-year survival was 29.2%. Salvage CABG is associated with high risk of immediate mortality and severe adverse events. However, the observed immediate and intermediate outcome justify coronary surgery in these critically ill patients. A number of these patients are currently treated by ECMO, and its results are encouraging. (C) 2015 Elsevier Inc. All rights reserved.
引用
收藏
页码:1193 / 1198
页数:6
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