Aortocoronary bypass in the diabetic patient

One hundred twelve patients undergoing aortocoronary bypass—35 with diabetes of adult onset and 77 without diabetes—were studied to determine whether diabetic patients have additional operative risks and greater operative mortality and whether their coronary disease differs from that of nondiabetic patients. Among the diabetic patients there was a greater prevalence of preoperative unstable angina, prior myocardial infarction and class IV functional disability (New York Heart Association criteria). The major coronary arteries angiographically and at operation appeared similar in both groups. The blood flow rates measured in aortocoronary bypass vein grafts were similar in both groups, raising doubt about the presence of microvascular disease in the myocardium of the diabetic patient. Preliminary follow-up results demonstrated relief of anginal symptoms in 76 percent of diabetic and 78 percent of nondiabetic patients. The operative mortality rate of 9 percent in diabetic and 4 percent in nondiabetic patients occurred among the first 40 patients in the series; no patient in either group has died in the immediate postoperative period during the last 18 months of the study.

Aortocoronary bypass should be recommended to diabetic patients with symptomatic coronary arteriosclerosis using the same criteria for operability applied to the nondiabetic population.     

Aortocoronary venous bypass operation in the elderly

On the extended diagnosis for an aorto-coronary venous bypass operation, with a greater involvement of patients with instable angina pectoris symptomatik (inApS), left main artery disease (LAD), aneurysmal resection, and "bad" ventricle (ejection fraction global less than or equal to 30%), the preoperative risk was evaluated in n = 600 patients. In a total of n = 150 patients with preoperative high-risk constellation perioperative parameters were monitored to find complications (perioperative myocardial damage [PMD], cardiac low output syndrome [LOS]). Among them were n = 40 patients aged greater than 60 years (60-72), their average age being 62.9 years. In 30% of these older patients the preoperative high-risk constellation was confirmed: 15% PMD, 10% LOS, and 5% deceased. The further postoperative course (up to the 6th month) is objectified by the ejection fraction global (EFg) by multiple checks. As a whole, patients greater than 60 years with extended diagnosis for ACVB operation do not show any significant increase in hospital mortality, but an increase in PMD and LOS (p less than 0.001) compared to the age group less than 60 years. With corresponding individual intensive-therapeutic measures, however, both complications can be controlled in the majority of patients. Despite the demonstrated higher perioperative risk, the urgent ACVB operation proved to be strategically right (considering the results of EFg) for increasing the quality of life and improving the expectation of life also for patientes greater than 60 years, in particular with the operation indications of inApS and LAD.(ABSTRACT TRUNCATED AT 250 WORDS)     

Aortocoronary dissection complicating a percutaneous coronary intervention

Aortocoronary dissection complicating diagnostic angiography or percutaneous coronary intervention is a rare occurrence. We present a case of aortocoronary dissection complicating a right coronary artery intervention. After closing the entry port with intracoronary stenting, the patient was managed conservatively. Serial computed tomography scans demonstrated spontaneous resolution of the dissection.     

Aortocoronary saphenous vein graft rupture during diagnostic angiography

Coronary saphenous vein graft (SVG) rupture during diagnostic angiography is a very rare but known complication of the procedure. It has typically been reported to occur at the site of pseudoaneurysms or secondary to an interventional procedure involving the graft. We present a case of SVG mid‐body rupture during diagnostic angiography that occurred without evidence of pseudoaneurysmal changes. © 2013 Wiley Periodicals, Inc.     

Aortocoronary shunting in the early period after myocardial infarction

Fourteen patients aged 34-54 years underwent aortocoronary bypass surgery for early postinfarction angina within 30 days following myocardial infarction. In periods up to 1.5 years after surgery, angina pectoris was not detected in the patients; cases of recurrent myocardial infarction were not registered.