Emergency Coronary Artery Bypass Graft Surgery for Acute Coronary Syndrome

Timing and protection of the heart during coronary artery bypass(CABG) for acute coronary syndrome(ACS) are challenging and important. Although prompt surgical revascularization may minimize myocardial loss and decrease reinfarction, early reperfusion has been theorized to result in peri-infarct hemorrhage, edema, and necrosis, according to experimental models. In a systematic review of the literature as well as our experiences we are addressing the timing of CABG and protection of the heart in ACS. With the advent of systemic thrombolysis and percutaneous coronary interventions (PCI), a lower volume of coronary anatomy not suitable for PCI will continue to CABG . The timing of CABG after an acute MI is a debatable topic. The time by itself is an unreliable criterion to decide on surgical revascularization, but the acuity of illness is a major determinant of outcomes. Delaying surgical revascularization may be reasonable if reversal of the acuity of illness is expected. Elevated troponin levels carry a higher operative risk that has to be balanced with the risk of progression of myocardial injury with further delay in revascularization. Strategies for myocardial protection in ACS is being intensively debated at present. Overall, routine patients may achieve an excellent outcome with either type of protection procedure but there are varying results from different studies comparing beating and arrested heart coronary artery bypass graft procedures in ACS. Patients with evolving acute coronary syndrome , defined as continuum from unstable angina (UA) to non– ST-segment elevation MI (NSTEMI) to ST-segment elevation MI (STEMI) display a high-risk entity in CABG surgery. In presence of refractory symptoms and hemodynamic alterations, emergency surgical therapy within the first hours is indicated. It can be speculated that preserving native coronary blood flow during operation to reduce reperfusion injury or no reflow phenomenon . We analyze the impact of preserved native coronary blood flow and kind of protection during emergency treatment for ACS for better outcomes.