Comparison of postoperative outcomes between emergently bypassed patients without preoperatively implanted stents, with preoperatively implanted bare metal stents (BMS) and with preoperatively implanted drug eluting stents (DES)

Objectives: Patients with severe coronary heart disease can receive PTCA, coronary bypass operation or both. Different benefits, complications and postoperative outcomes of patients who only received bypass operation or both were compared.

Methods: Data of 217 patients in 3 groups were analyzed retrospectively. In 160 patients (43 female; age: 67.5±10.1 (30–92) years) no coronary stent was implanted before surgery (G1). In 34 patients (8 female; age: 65.7±7.6 (50–79) years) already bare-metal-stents were implanted before operation (G2) and 23 patients (7 female; age: 64.9±9.2 (42–79) years) received drug-eluting-stents before surgery. All patients underwent surgery because of acute myocardial ischemia like myocardial infarction (MI) or acute coronary syndrome (ACS) (n=215) or cardiac tamponade after perforation of a coronary vessel during PTCA (n=1 each in G1 and G2).

Results: Perioperative complications were due to coagulation difficulties (G1:n=13; G2:n=4; p=0.30), surgical issues (G1: n=3; G2: n=3, G3: n=3; p=0.03), severe bleeding difficulties with revision (G1: n=6; G2: n=5; G3: n=2; p=0.03), occlusion of bypasses/stents (G1: n=3; G3: n=3; p=0.025), difficulties in weaning from the extracorporeal circulation (G1: n=4; G2: n=2; p=0.35), coherences with cardiac low output (G1: n=19; G2: n=3; p=0.23), severe ECG-changes up to resuscitation (G1: n=13/G2: n=5/G3: n=2; p=0.49) and death (G1: n=1). Also analyzed were application of IABP/IABP+ECMO(G1: n=39/G2: n=9/G3: n=5; p=0.09), administration of blood products (G1: 121±7.7; G2:14.7±13.2; G3:10.0±3.9 (summed FFP-, EC- and TC-units); p=0.79), days of ventilation (G1: 2.8±7.4; G2: 2.6±2.8; G3: 1.8±1.9; p=0.22) and days on the ICU (G1: 6.1±9.9; G2: 5.8±5.2; G3: 4.4±3.4; p=0.29).

Conclusion: Although admitted under different preconditions, the patients suffered from similar postoperative states. Only patients of the DES-group experienced certain perioperative complications like bleeding, surgical issues and occlusion of stents/bypasses more often.