CORRESPONDENCE: LETTERS TO THE EDITOR
Reply
John G. Byrne, MD, FACC*
* Vanderbilt University Medical Center, Department of Cardiac Surgery, 2311 Pierce Avenue, Nashville, TN 37232-8815 (Email: john.byrne{at}vanderbilt.edu).
In reply the comments of Dr. Perrault and colleagues, our study group (n = 26) was a very high-risk group, with multiple co-morbidities all requiring emergent or urgent procedures (1). The predicted operative mortality, had emergency coronary artery bypass graft (CABG) valve surgery been performed at the time of percutaneous coronary intervention (PCI), was >20%. All patients presented with acute coronary syndromes; many had low cardiac output or shock and nearly half were reoperations. By stabilizing the patients with PCI to the culprit vessels, we were able to lower the observed operative mortality to about 4%. The benefit to the patients in our study was not just minimizing the surgical trauma (concomitant CABG was not needed in any patient requiring reoperation) but also the benefit of time to allow for improved patient status. We acknowledge that some patients who underwent emergency PCI to a culprit vessel, who had known valve disease, may not have been offered surgery during their hospitalization because they did not improve to the level deemed operable, or were deemed too stable and sent home for later elective valve surgery. Although statistical analysis is not possible, as described in our study, most clinicians would agree that the observations in this study have meaningful clinical benefit.
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References
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1. Byrne JG, Leacche M, Unic D, et al. Staged initial percutaneous coronary intervention followed by valve disease J Am Coll Cardiol 2005;45:14-18.[Abstract/Free Full Text]
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