Coronary artery bypass grafts in patients with coronary stents

Luis S. M. Fragomeni, Roque P. Falleiro, Gustavo Hoppen, Guilherme Krahl
2005 Brazilian Journal of Cardiovascular Surgery  
RBCCV 44205-774 Revascularização cirúrgica do miocárdio em pacientes com stents coronários Coronary artery bypass grafts in patients with coronary stents Abstract Objective: To observe the surgical characteristics of patients operated on after percutaneous coronary interventions (PCI). Method: Fifty-six patients (41 M and 15 F), at the time of coronary artery bypass grafting (CABG), had already been submitted to coronary stenting procedures. In 101 PCI, 116 stents were implanted. At the time of
more » ... ted. At the time of the first PCI, 32 patients had three or more coronaries affected by severe stenosis. Six patients were treated with PCI for severe left coronary trunk stenosis. After the implantation of the first stent, 12 patients developed severe de novo lesions of the left coronary trunk. In 6 of these, stenosis developed within 6 months of stent implantation. Diabetes was present in 35.7% of the patients. In 22 patients (39.2%), at the time of CABG, the left ventricular function was reduced (p<0.001). During surgery, 160 grafts were implanted. Surgical studies included coronary and muscle biopsies. Results: Surgical observation showed more arteritis and inflammatory tissues adjacent to the stent when compared to other areas. Seventeen patients that could not have platelet antiaggregates withdrawn needed more blood transfusions. There were no hospital deaths. Conclusion: In patients operated on after stent implantation, facts like loss in LV function or de novo vascular lesions complicate surgical procedures and may impair longterm results. Due to endothelial dysfunction caused by stents, grafts may obstruct earlier. In addition the efficiency of clinical therapy may not be the same. Descriptors: Stents. Myocardial revascularization. Coronary atherosclerosis Resumo Objetivo: Analisar as características cirúrgicas de pacientes operados após a intervenção coronária percutânea (ICP). Método: Cinqüenta e seis pacientes (41 H e 15 M), no momento da revascularização cirúrgica do miocárdio, já tinham sido manejados com o implante de stents coronarianos. Foram implantados 116 stents em 101 FRAGOMENI, LSM ET AL -Coronary artery bypass grafts in patients with coronary stents Braz J Cardiovasc Surg 2005; 20(4): 371-376 intervenções. Trinta e dois pacientes tinham três ou mais vasos com estenose significativa. Seis pacientes com lesões graves no tronco da artéria coronária esquerda (TCE) foram tratados com stents. Desde a colocação do primeiro stent, 12 pacientes desenvolveram lesões de novo graves no TCE. Em seis (50%), a estenose grave se desenvolveu em até seis meses da colocação do stent. Vinte (35,7%) pacientes eram diabéticos. Em 22 (39,2%) doentes, no momento da cirurgia, havia diminuição significativa da fração de ejeção do VE (p< 0,001), quando comparada à da primeira ICP. A revascularização cirúrgica constou do implante de 160 enxertos coronarianos. A análise transoperatória incluiu biópsia da parede coronária e do músculo adjacente. Resultados: Achados transoperatórios evidenciaram tecidos BIBLIOGRAPHIC REFERENCES 1. Gomes WJ, Gianotti Filho O, Catani R, Paez RP, Hossne Jr. NA, Buffolo E. Alterações inflamatórias das artérias coronárias e do miocárdio induzidas por stents coronários. Rev Bras Cir Cardiovasc. 2002;17(4):293-8. FRAGOMENI, LSM ET AL -Coronary artery bypass grafts in patients with coronary stents Braz J Cardiovasc Surg 2005; 20(4): 371-376
doi:10.1590/s1678-97412005000400004 fatcat:fczkigebabby3g2nferjym65wy