Contribution of Frequent Use of Arterial Grafts in Emergent Coronary Artery Bypass Grafting.
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Purpose: Coronary artery bypass grafting (CABG) using arterial grafts has been utilized aiming at improvement of the long-term results and its indication has been expanded for emergent CABG. We report here our experience of emergent CABG in the arterial bypass era. Methods: We performed a retrospective study of emergent CABG for acute coronary syndrome to evaluate postoperative and remote results. Among 1997 consecutive patients who underwent isolated CABG between January 1, 1991 and December 31, 2000, a total of 154 were emergent cases. The inhospital and long-term data in these patients were analyzed using appropriate statistical methods. Results: The mean number of grafts performed by emergent CABG was 3.2±1.1. At least one arterial graft was used in 144 patients (93.5%). The patients who underwent emergent CABG required significantly longer intubation period, longer ICU stay and longer hospital stay than elective CABG. Major complications occurred in 73 cases (47.7%), and in-hospital deaths occurred in 11 cases (7.1%). Emergent surgery was one of the significant predictors of inhospital death by both univariate and multivariate analysis (relative risk 23.5 with 95% confidence interval 8.6-61.6). Among the hospital survivors, follow-up was completed in 98% of the patients with a mean follow-up period of 3.5 years. The actuarial 5-year event-free and survival rates after emergent CABG were 78.1% and 90.8%, respectively, which were not significantly different from elective CABG in which the actuarial 5-year event-free rate was 83.6% and the 5-year survival rate was 90.7%. Conclusions: Hospital mortality and morbidity were higher in the emergent surgery. However, once adequate surgical revascularization was completed, the long-term results in the emergent group were not inferior to those in the elective CABG group. Use of arterial grafts may have contributed improvement of its long-term outcomes.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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