Surgery after Complications of PTCA: An Overview on Strategy, Techniques, and Results

Guidelines of the American Heart Association [8] and of the German Society for Cardiac and Circulatory Research (Deutsche Gesellschaft fur Herz- und Kreislaufforschung) [7] both exclude patients from PTCA in whom myocardial infarction of life-threatening severity would follow an occlusion of the stenosis to be dilated. However, a certain rate of severe complications after PTCA seems to be inevitable, due to the unpredictable clinical course of an individual patient once myocardial ischemia has been produced [3]. The amount of myocardium at risk does not predict the severity of complications to be expected, because other factors such as arrhythmias, distribution of thrombembolic material, and extending dissection may suddenly convert a situation of stable ischemia into a catastrophic hemodynamic deterioration. It appears that even the most thoughtful indication for PTCA cannot completely rule out the need for emergency coronary surgery. A review of the surgical experience will outline our present surgical view of the problem.