Other CABG Risks
Between 5% and 15% of patients having CABG sustain intraoperative Q-wave AMI.[47,53,58,59] Patients with a perioperative myocardial infarction had an increased hospital mortality (about 10% to 15%) compared with about 1% for patients undergoing CABG who do not sustain a perioperative myocardial infarction. Perioperative AMIs have also been associated with about double the risk of subsequent cardiac events, including death, in the year following surgery. About two thirds of the postoperative mortality is caused by pump failure, and about one third is due to malignant ventricular tachyarrhythmias.
Multifactorial coagulation abnormalities occurred postoperatively in CABG patients, often requiring considerable amounts of blood products to control the bleeding. Even with optimal medical management, about 5% of patients needed to return to the operating room for control of bleeding.
Viral infections due to perioperative transfusions for CABG-related bleeding included cytomegalovirus, hepatitis B and C, and rarely HIV. A postoperative sternal infection leading to mediastinitis occurred in about 2% of cases overall and much more often in patients receiving bilateral internal mammary artery grafts.[62,63,64] The mortality of mediastinitis varied between 10% and 25%.[65,66] Cellulitis at the site of saphenous vein harvesting has recurred months or years later.
Clinical or subclinical deep venous thrombosis happened in about a third to half of patients undergoing CABG. Approximately 0.5% of patients had clinically important pulmonary emboli, about a third of which were fatal.
A variety of gastrointestinal complications following CABG, many requiring surgery, had a mortality of 1-1.5/1000.[69,70] Renal failure occurred postoperatively in 4.9% of CABG, with about 2% requiring dialysis. Post-CABG renal failure patients suffered a markedly increased mortality.[71,72,73] About 10% of patients after CABG had central nervous system complications, including stroke, visual disturbances, depression, and decreased cognitive function.[74,75,76]
© 2002 Medscape
Cite this: Coronary Artery Bypass Grafting (CABG): Reassessing Efficacy, Safety, and Cost - Medscape - Jun 19, 2002.