Emergency Reoperation within 24 hours After CABG (For Other Causes than Bleeding)

Objectives: Early graft failure after CABG is a rare but a dramatic outcome.it may be manifested in the intensive care unit by arrhythmias low cardiac output states or ECG changes. Patients and Methods 3000 patients between the year 2000 and 2004 were operated upon for CABG. Reexploration for bleeding were excluded from the study. I2patients(0.4%)were reexplored for either significant ECG changes, persistant ventricular arrhythmias or hemodynamic instability with low cardiac output states. Results The 12 patients were re-explored .An additional graft to the left anterior descending artery was added(8patients) ,revision of the anastomoses to obtuse marginal artery in one patient ,revision of posterior descending artery graft in another patient and untwisting and repositioning of the grafts in 2 patients. The cause of graft failure was either due to inadequate left internal mammary artery flow,twisting of the saphenous vein graft or due to thromboses of the native coronaries and the grafts. 3(25%) patients died out of low cardiac output states. 9patients had a significant improvement in their hemodynamics and resolution of their ECG changes without new Q waves . Conclusin: An aggressive approach for the patients with hemodynamic and ECG changes is required to restrict the myocardial damage.Surgeons should not be reluctant to reexplore their patients as this may be their only resort.