1. The dilemma of coronary artery bypass grafting following right coronary artery stenting – ‘To graft or not to graft?’
Krithika Ramaprabhu, Gopal Murugesan, Vijit K Cherian, Bashi.V. Velayudhan
MIOT HOSPITALS, 4/112,MANAPAKKAM ,CHENNAI, TAMIL NADU , INDIA
AIM OF THE STUDY
The aim of this study was to evaluate a subset of coronary artery bypass grafting patients, who had previously undergone stenting of the right coronary artery.
We sought to assess the various operative strategies and outcomes in this complex group of patients
MATERIALS AND METHODS
PATIENT DEMOGRAPHICS
Mean age was ± 6.42 years, Range - 44 to 68 years
Male patients - 12 (70.5%) ; Female patients - 5 (29.5%)
10 were Diabetic (58.8%) and 8 (47%) were Hypertensive.
13 (76.47%) presented with Angina, 2 patients in Cardiogenic shock requiring ventilator support
Mean Ejection Fraction : ± 10.7%
SEVERE INSTENT RESTENOSIS OF RCA
Study Group :17 patients with previous stenting of the Right Coronary Artery who underwent coronary artery bypass grafting
Type of Study : Retrospective Observational study
Study Period : from June 2014 to June 2016
Data collected : Preoperative data, Grafting strategies and Postoperative outcomes were analyzed.
PREOPERATIVE PCI DETAILS
Isolated right coronary artery stenting was done in 12 patients (70.5%)
The LAD was additionally stented in 4 patients ; All of them were drug eluting stents
Inferior wall Myocardial Infarction in 10 patients (58.8%)
8 patients had patent stents and 9 patients had stenosed Right coronary artery stents.
RESULTS
All of them were done on Beating Heart.
There was no in-hospital mortality.
Four of the native Right coronary arteries were ligated distal to the stent and then grafted.
A patient who had a patent stent was re-explored for persistent arrhythmias, and venous grafting was done to the PDA (Posterior descending artery) and distal LAD
The internal mammary artery was not used only in one patient.
The postoperative ejection fraction was 56.5 ± 10.7%.
CONCLUSION
Although it is a fairly straightforward concept to graft the right coronary system when the stent is blocked and leave it alone when the stent is patent, the altered hemodynamics and coagulation profile during surgery may result in stenosis of a previously patent stent.
Thus, this complex subset of patients has to be carefully evaluated and appropriate grafting strategies have to be employed as required.