CARDIOVASCULAR ENGINEERING Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
	Volume 2, 1997, No 4

Intraoperative rt-PA Lysis as Emergency Therapy after Acute Coronary Artery Bypass Thrombosis

M. Breuer, A. Schütz, W. Eichinger, B. Gansera, J. Weingartner, B. M. Kemkes

Abstract:
Acute graft occlusion early postoperatively after CABG is a rare but dramatic complication, frequently making resucitation necessary. Emergency reoperation with reanastomosing of the conceming grafts is the normal procedure to restrict the otherwise unavoidable myocardial damage. Lethality in these cases is up to 501/o. Dut to this unsatisfying situation since 7/1995 we have been performing an adjuvant intraoperative intracoronary installed rtPA lysis on these patients. Between 1/1993 and 7/1997 4149 patients underwent coronary artery bypass grafting. In 15 of these cases emergency reoperation within the first 12 hours after CABG due to clinical signs of acute myocardial infarction was necessary. On six patients (group 11) intraoperative rtPA lysis of the involved vessel/s has been performed. When the peripheral anastomosis was re-opened and the thrombotic material was removed we inserted for this a LA-catheter of 1.2 mm in diameter into the coronary artery. Then we administered within 2-3 min up to 100 mg rtPA(t1/2: 4.4 min) locally into the coronary artery. Aprotinine was not applied in group II. All patients were treated postoperatively with ASA 1000 mg and heparine. In group 1 (n=9; 7m, 2f) without lysis therapy 7 patients (78%) developed a severe myocardial infarction after reintervention. Three of these patients could not be stabilized, not even with the help of high dose medicamental support. They died during or early after the redoing procedure due to low cardiac output syndrom. In group 1 Ck-leve ' Is were significantly enhanced (Ck max x=1254 U/l; 965-1431 U/l, p <0.01). in comparison the ck-levels in group 11 ranged between 342-632 u/1 (x="465" u/1). two patients of group 11 had a myocardial infarction but none of them died. bleeding in group 11 was comparable with that of other redoing procedures (x="1" 164, 520-1560 ml). lysis-associated complications could not be observed. reoperation of patients with acute thrombotic bypass occlusion after cabg is characterized by a high mortality and morbidity. lf additionally rtpa lysis is performed, a sufficient myocardial perfusion seems to be restored. due to the local application and the short period of effectiveness of rtpa, the bleeding following intraoperative lysis therapy is tolerable. rtpa lysis after acute graft thrombosis seems to re-establish the entire macro- and microcirculation of the relevant myocardial area thus preventing an otherwise unavoidable severe myocardial infarction. the application procedure is easy, harinful complications were not seen.

Address for Correspondence:

Reference:
(CVE. 1997; 2 (4): 257-259)

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