Coronary Artery Surgery by F. Loogen (auth.), Universitäts-Professor Dr. med. Felix

By F. Loogen (auth.), Universitäts-Professor Dr. med. Felix Unger (eds.)

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Late angiographic studies were performed in 13 patients (mean 12 months postoperatively). Thirteen vesseis were analyzed after preoperative antegrade coronary artery dilatation. In comparison to the preoperative angiograms, the late arteriograms revealed that six arterial narrowings (46%) were unchanged, three (23%) were worse (one of which was totally oeduded), while four (31 %) were improved. Of the two segments which revealed early angiographic evi den ee consistent with intimal damage, both showed late evidence indicating healing.

In one case in which the flow from the internai mammary artery did not seem satisfactory, the artery was transected at the origin and used as a free graft in aortocoronary position. Proximal anastomosis in this case was performed with a running 7 -0 polypropylene suture. PTCA was usually performed during the first coronary angiography after consultation with the surgical team. Only in two cases, studied in other institutions, was PTCA performed during a second coronary angiography. 22 Results Group A: Medical Treatment Two patients (9%) died from aeute myoeardial infaretion within 6-12 months.

Those three patients had diffuse lesions and global hypokinesia. Despite prolonged circulatory assistance and intraaortic balloon pumping they could not be weaned off bypass. Two noncardiac causes of death were a massive pulmonary embolism (day 12) and a cerebrovascular accident (day 32). One patient died ofunexpected ventricular tibrillation. Reversible postoperative complications were the following: four tamponades, three low-output syndromes, nine rhythm disturbances (atrial tibrillation, flutter).

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