Intra aortic balloon counterpulsation in coronary artery disease: indications, complications and current practice

As the proportion of high risk patients with coronary artery disease, submitted for either interventional cardiology or surgical procedures increases, use of intra-aortic balloon counterpulsation [IABC] has increased, especially as preoperative therapy. Although the efficacy arid cost-effectiveness of IABC have been demonstrated, historically higher complication rates have dissuaded some doctors from IABC use. In this review indications, complications, outcomes as well as current and future IABC practices, in relation to coronary artery disease are high-lighted. Widened indications for IABC use, particularly as preoperative therapy in high-risk patients, have lead to better patient outcomes arid improved IABC technology. This has led to increased use of IABC with lower complication rates than previously reported in the literature

Postoperative thrombocytosis after coronary artery bypass grafting: a potential danger even after hospital discharge

Thrombocytosis [platelet counts >400 ' 103/mm3] following coronary artery bypass grafting has been described to occur frequently [20-30%] and to be associated with thrombotic complications postoperatively. The purpose of the present study is to establish when the peak value of platelet count occurs, and how high it is, as well as to determine the duration of thrombocytosis. Thirty consecutive patients undergoing elective coronary artery bypass grafting, who subsequently developed postoperative thrombocytosis [group 1] were considered for the study. Another 30 patients with platelet counts within normal limits postoperatively served as controls [group 2]. Platelet count was monitored on a weekly basis during 5 weeks postoperatively. Patient characteristics, operation data and cardiopulmonary bypass data in group 1 did not differ from group 2 patients, except for a higher incidence of hyperlipidemia, i.e., 97% [29/30 patients] in group 1 compared to 40% [12/30] in group 2 [p < 0.001]. Neither deaths nor nonfatal myocardial infarctions occurred during the study period. Postoperative thrombocytosis was diagnosed on 6.1 +/- 1.5 days postoperatively, and peak platelet count reached 14 +/- 4.0 days postoperatively [6-21 days]. The highest platelet count observed was 905,000/mm3. Platelet counts returned to normal values within 5 weeks. Three late vein graft occlusions occurred in all groups, and thus coinciding with the maximum platelet count observed. Conclusions: Postoperative thrombocytosis is a potentially dangerous complication, with an increased risk for vein graft occlusion. Postoperative thrombocytosis, when it occurs, is diagnosed around the 6th postoperative day, reaches its peak 2 weeks postoperatively and may last as long as 5 weeks. Close surveillance of patients with postoperative thrombocytosis is emphasized

Coronary artery bypass grafting combined with valvular surgery the challenge of reoperative surgery

Untreated or undetected coronary artery stenosis has been blamed for death or failure to improve following valve replacement/repair. Combined surgery [CABG + valve] has therefore been introduced. With an increasing number of patients requiring cardiac surgery for the second time [REDO's], the present study was undertaken to evaluate results after primary and REDO combined cardiac surgery. A total of 138 patients underwent combined coronary artery and valvular operations between January 1, 1984 and December 31, 1993. one hundred twenty-four patients had primary surgery [Gr. I] and 14 operations were REDO's [Gr. II], 10.2%. there were73% coronary artery bypass grafting [CABG] and simulataneous aortic valve replacement [AV], 23% CABG + mitral valve repair/ replacement [MV] and4% had CABG combined with double valve replacement [DV], with a similar incidence in both groups. The average age in Gr. I was 66.9 +/- 10.2 compared to 67.7 +/- 7.3in GR. II. [n. s.]. sex distribution and prop. Risk factors did not differ between the groups. Seventy-five% of the patients were in prop. NYHA class 3 and 4 in both groups and there was 15% urgent operations performed. Preop. Left ventricular ejection fraction was 42.2 +/- 18.9% in Gr. I and 52.9 +/- 9.5%, p<0.001. Gr I patients received 2.7 +/- 1.4 grafts/ patient, while Gr. II patients had 1.4 +/- 0.8grafts/patient, p<0.001. other operative data did not differ. The overall mortality was 10.4% in Gr I and 21.4% in Gr II, p<0.05 low cardiac output was frequently observed, 23% in both groups, while the incidence of other postoperative complications was low and did not differ significantly between the groups. Significant risk factors for perioperative mortality in Gr. I were: Age>65 years [p<0.001], CABG + DV[p<0.001], LVEF<40% [p<0.05], and in Gr. II: Age>65 years [p<0.001], p<0.05. 3-years survival and event-free survival rates were good in both groups. Combined valve repair/replacement and CABG surgery is associated with a 11%perioperativee mortality but encouraging long term results. REDO combined cardiac surgery carries significant mortality, but could be considered in selected patients because of excellent long-term results. Double valve procedures not recommended in combined cardiac surgery reoperations