The Annals of Thoracic Surgery, Vol 28, 501-508, Copyright © 1979 by The Society of Thoracic Surgeons
The importance of myocardial protection in combined aortic valve replacement and myocardial revascularization
DC Lundell, H Laks, AS Geha, VB Khachane and GL Hammond
To determine the importance of different methods of myocardial protection
for combined aortic valve replacement and coronary revascularization, we
analyzed the records of 82 consecutive patients who underwent the combined
procedure between 1973 and 1978. Sixty-three (77%) had angina and 63 (77%)
were in New York Heart Association Functional Class III or IV. Moderate to
severe left ventricular impairment was present in 59%, and the mean number
of diseased vessels was 1.9 per patient. Group I consisted of 18 patients
with intermittent ischemia, almost all of whom had operation between 1973
and 1976. Group IIa consisted of 24 patients operated on between 1973 and
December, 1976, with coronary perfusion, and Group IIb had 18 patients in
whom a similar technique was used in 1977 and 1978. Group III consisted of
22 patients operated on in 1977 and 1978 in whom cold chemical cardioplegia
was used. The early mortality (less than 30 days) for Group I was 50% and
for Group IIa 29%. There were no deaths in Group IIb and Group III. The
incidence of perioperative myocardial infarction was 21% in Group I, 6% in
Group IIa, 11% in Group IIb, and zero in Group III. The incidence of
cardiogenic shock requiring prolonged inotropic support and intraaortic
balloon counterpulsation was significantly less in Group III (9%) than in
Group IIb (50%) (p less than 0.05). If other manifestations of myocardial
injury, such as perioperative infarction and cardiogenic shock requiring
intraaortic balloon counterpulsation or inotropic support, are taken into
consideration, cold chemical cardioplegia appears to provide better
myocardial protection than coronary perfusion of the fibrillating heart.
