Raheel Hussain.
Surgical revascularisation in acute coronary syndrome
Pak J Cardiol Sep - Dec 2005;16(3):121-6.
Dow University of Health Sciences, Karachi

A retrospective review of single surgeon database over a period from April 2000 till July 2005 was done. Altogether 362 patients were operated for coronary artery bypass grafting (CABG). 48 patients qualified to be included under the above definition of acute coronary syndrome. RESULTS: Over a period of five years and three months, 48 patients with ACS were operated. Among them 32 suffered from unstable angina with fresh and/or dynamic ST depression. Thirteen patients had non-ST elevation MI. And the rest 3 patients had inferior wall ST-elevation MI. All patients had angiography within 72 hours of surgery. Two or more vessels were found to be involved including the culprit artery in all except one. Foremost reason for surgical referral was higher cost of intervention treatment. In 29 patients severe three vessel disease clinically was a direct indication for bypass grafting. General anesthesia was administered with invasive arterial and central venous pressure monitoring. Internal mammary artery was used in all, except two cases. Coronary grafting was performed on stationary heart. Myocardial protection was achieved with cold sangeous antigrade cardioplegia with topical cold. Cardioplegia was repeated through each graft after completion and also through the aortic root. Intra-aortic balloon counter-pulsation was employed in two patients. Average grafts per patient were 3. One patient with 20% EF and unstable received only sephenous vein conduit to critical left anterior descending artery lesion. Three further patients received two grafts, a sephenous vein and internal mammary artery. Six patients received four grafts each; with one internal mammary artery and rest saphenous vein conduits.

Category: Cardiac Surgery
Keywords: Ischemic Heart Disease. CABG. Coronary Artery Bypass Grafting.

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