Multivessel coronary stenting versus bypass surgery in patients with multivessel coronary artery disease and normal left ventricular function immediate and six months follow up

The usual goal for CABG is complete revascularization, which may be associated with greater freedom from recurrent angina and better long-term survival. In selected patients with multivessel coronary artery disease and normal left ventricular function, intracoronary stenting may offer an effective alternative to coronary bypass surgery. was to compare the immediate and six months follow up of the results of percutaneous coronary intervention [PCI] and the conventional coronary bypass surgery [CABG] in symptomatic patients with multivessel coronary artery disease and normal left ventricular function. The study included 61 patients who were randomly selected and divided into two groups: group [1]: 33 patients who underwent CABG and group [2]: 28 patients who underwent percutaneous coronary intervention. Both groups were followed up immediately post procedures and for a period of six months after. Stress ECG was done for returning patients during the 6 months follow up. During the immediate post operative follow up, only one patient in group 1 [3%] and 19 patients in group 2 [67.6%] were free of complications [P<0.001] Postoperative angina, acute renal failure, need for inotropic support, blood transfusion and lung atelectasis were significantly higher in group [1] than group [2]. Coronary dissection was found only in the PCI group. Other complications found in both groups were of no statistical significance. Regarding the cost and hospitals stay, it was significantly higher and more in group [1] than group [2]. During the 6 months follow up of the symptoms and the level of activity, there was no statistically significant difference regarding the angina and positive stress test between both groups. There was no statistical difference between the two groups in the composite end points [exercise tolevance, incidence of angina and mortality] during the 6 months follow up after the operation. PCI is relatively safer procedure, less costly and with lower hospital stay than CAVG, but it should be done in the presence of surgical back up because it is not completely free of risk and disadvantages. CABG still will have its role in managing patients with complex lesions not amenable to catheter interventions

Post-operative hemodynamic study for evaluation of intracardiac repair of tetralogy of Fallot

Between 1987 and 1989, 36 patients with tetralogy of Fallot underwent total correction operation. Post-operative cardiac catheterization and Doppler echo studies were performed during the follow-up period that ranged between 3 to 24 months. The post operative catheterization revealed the intracardiac pressure improvement in comparison to the pre-operative pressures, residual VSD was detected in 7 patients; 5 patients with VSD were asymptomatic, post-operative tricuspid incompetence was detected in 2, and the residual right ventricular outflow tract pressure gradient [RVOTG] was measured. Catheterization was superior to Doppler echo in detecting and calculating the residual shunt. Functional state of the patients was graded according to the catheterization data. 22 patients showed excellent functional results, 7 showed fair results, and in 7 patients the functional results were poor; of them 2 late post-operative mortalities were encountered. Post-operative catheterization or Doppler echo study are essential for assessment of the results of surgical repair of tetralogy of Fallot