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Ann Thorac Surg 1978;25:413-424
© 1978 The Society of Thoracic Surgeons

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Articles

Criteria for Operability and Reduction of Surgical Mortality in Patients with Severe Left Ventricular Ischemia and Dysfunction

Divisions of Thoracic Surgery and Cardiology and the Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA

^* Address reprint requests to Dr. Jones, Emory University Clinic, 1365 Clifton Rd, NE, Atlanta, GA 30322

A series of 188 patients who were operated on for left ventricular ischemia and dysfunction is presented. Angina was a prominent symptom in all patients, and a history of congestive heart failure could be elicited in 20%. Mean ejection fraction for the series was 0.35, with 67% having an ejection fraction of 0.35 or less and 24%, 0.20 or less. Complete revascularization was accomplished whenever possible; more than 70% of the patients had triple-vessel disease, and single bypass was performed infrequently (5%). Factors thought to be important in achieving a low operative mortality (2.1%) were: precise prebypass monitoring, particularly with the V5 precordial lead; maintaining a low rate-pressure product (<12,000) prior to bypass; myocardial preservation with cold hyperkalemic or hyperkalemic-hyperosmolar solution; and careful titration of inotropic and vasodilator drugs. Inotropic drugs and intraaortic balloon pumping were used frequently in this series. The late mortality was 4.3%. Angina was completely relieved or improved in 94% of the patients. Those having a history of congestive heart failure had an increased late mortality rate, four times that of the entire series.

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