Between July 1981 and February 1990, 2431 patients underwent attempted percutaneous transluminal coronary angioplasty (PTCA). Seventy-nine (3.2%) patients subsequently underwent emergency miocardial revascularization, and 32 (40.5%) developed myocardial infarction with 12 (15.2%) deaths. The operative mortality rate was significantly increased among elderly patients, those with left main occlusive dissection, late coronary thrombosis, and specially among patients with hemodynamic instability after PTCA. Additional minutes or hours of low myocardial and systemic perfusion after failed PTCA also increase the risk of immediate surgical revascularization. Despite the growing role of PTCA in the treatment of more complex coronary atherosclerotic heart diseases, the number of failed procedures that necessitate coronary artery bypass surgery decreased last two years (10/1351). This have been possible by placing a reperfusion catheter (Stack) across the narrowed coronary artery lumen. Surgical results were consistently improved by modifications in myocardial protection techniques, besides the use of reperfusion catheter after failed PTCA.
myocardial revascularization; myocardial revascularization; myocardial protection