The Journal of Thoracic and Cardiovascular Surgery, Vol 92, 847-852, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Percutaneous transluminal coronary angioplasty. A growing surgical problem
US Page, JE Okies, LQ Colburn, JC Bigelow, NW Salomon and AH Krause
The incidence of prior percutaneous transluminal coronary angioplasty in
surgical cases is nearly doubling yearly. In 1985, 11.4% of our bypass
patients had one or more prior angioplasties. One hundred thirty- five
patients with prior angioplasty are compared to 2,205 patients without
angioplasty undergoing surgical revascularization. The mortality is 3.2
times higher in the angioplasty patients than in the control patients and
the perioperative infarction rate is 2.5 times higher. Forty-four patients
were taken directly to the operating room from the catheterization
laboratory, 50 were operated on within 10 days, and 41 underwent operation
more than 10 days after angioplasty. All of these late failures were of the
lesion previously dilated. The infarction rate was less in patients taken
immediately to the operating room on an emergency basis than in those whose
operation was delayed up to 10 days (30% versus 70%). All patients who died
had angioplasty of the anterior descending coronary artery. Angioplasty of
this artery increases operative mortality should surgical treatment become
necessary acutely. Patients should be informed before angioplasty of the
increased surgical risks after a failed angioplasty procedure.
