Emergency Coronary Artery Bypass Grafting after Failed Angioplasty

Of 602 patients who underwent percutaneous transluminal coronary angioplasty in a 6-year period, 18 required emergency coronary artery bypass grafting within 12 hours of the procedure. The indications for emergency surgery were acute myocardial infarction in 5 patients, coronary artery dissection in 4, ventricular fibrillation in 3, unstable angina pectoris in 2, total coronary occlusion in 3, and cardiogenic shock in 1 patient. All patients were taken to the operating room in a deteriorating hemodynamic state; 4 received vasodilatating agents and another 4 were treated with vasodilators and inotropic agents, intra-aortic balloon pumping was used in 7, an autoperfusion catheter in 1, and 1 other required external cardiac massage. One patient was operated on in the catheterization laboratory. There was 1 death, giving an operative mortality of 5.6%. The internal thoracic artery was used for coronary artery bypass grafting in 7 patients. There were no deaths during the long-term follow-up.