SATS 2009 Final Program - Scandinavian Association for Thoracic ...

P01:20
SURGICAL REVASCULARIZATION AFTER ACUTE MYOCARDIAL INFARCTION, IS IT RUNNING
AGAINST THE CLOCK?
Abdel Aal Mohamed 1
1) Riyadh, Saudi Arabia
Objective
The optimal timing for surgical revascularization after acute myocardial infarction (MI) remains controversial. Higher
mortality for emergency coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI), ranging
from 5% to 30%, has been documented since the early 1970.
Patients and methods
We examined our experience retrospectively in 278 patients who underwent CABG between 2005 and 2007 at
king Fahad cardiac center in king khaled university hospital, Riyadh, Saudi Arabia. We had three groups one who
underwent CABG within 24hours (group 1) , group 2 between 1 to 3 days and last group 3 after 14 days.
Results
The operative mortality associated with increasing time intervals between MI and CABG were 11.68%, 7.05%,
2.5 %, for group 1(within 24 hours), group 2 and 3 respectively. In comparison, the incidence of cerebrovascular
(CVA) and atrial fibrillation (AF) were greater in group 1 and the length of ICU stay was longer for patients
undergoing CABG early after MI (within 24 hours). Emergency coronary artery bypass grafting (CABG) after
AMI within 24 hours (group 1) has a significantly higher risk.
Conclusion
Nonemergency surgical revascularization can be done safely at any time interval after acute myocardial infarction,
certainly after 72 hours, without increase in operative mortality and acceptable
P01:21
SURVIVAL BENEFIT OF CORONARY ENDARTERECTOMY IN PATIENTS UNDERGOING COMBINED
VALVE AND CORONARY BYPASS GRAFTING
Javangula Kalyana 1 , Papaspyros Sotoris 1 , Nair Unnikrishnan 1
1) Leeds General Infirmary, United Kingdom
Objectives
Coronary Endarterectomy (CE) in patients undergoing coronary artery graft (CABG) surgery has been shown to
be useful in re-vascularization of patients with diffuse disease. We present our experience with CE in patients
undergoing valve surgery combined with coronary bypass.
Methods
Between 1989 and 2008, 237 patients underwent CABG with valve surgery under a single surgeon. Of these, 41
patients had in addition CE. The data was retrospectively obtained from the notes and database. The follow-up
was obtained by telephonic interview. All variables were analyzed by univariate analysis for significant factors for
in hospital mortality. Morbidity and long term survival was also studied. There were 29 males and 12 females with
a mean age of 67.4 ±8.1 and body mass index of 26.3±3.3. Their mean euroscore was 7.6±3.2 and the log euro
score was 12.2 ± 16.1.
Results
In hospital mortality was 9.8% (4 out of 41) with 6 late deaths. Long-term survival at 10 years was estimated to
be 57.2% (95% CL 37.8%-86.6%). Average hospital stay was 12.7±10.43 days. ICU stay was < 48 hours in 32
patients.The symptom relief was noted in majority with only 3 of the survivors having NYHA class II symptoms. One
of the survivors was on nitrates and none required any further percutaneous or cardiac surgical intervention.
Conclusions
Coronary Endarterectomy does not increase mortality in combined procedures. By achieving more complete
revascularization, it may be offering survival benefit in this group of patients. However this needs to be confirmed
on studies with larger number of patients.
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