HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Dwight C. Lundell Hillel Laks Alexander S. Geha Vasant B. Khachane Graeme L. Hammond Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lundell, D. C. Articles by Hammond, G. L. Search for Related Content PubMed PubMed Citation Articles by Lundell, D. C. Articles by Hammond, G. L.

Ann Thorac Surg 1979;28:501-508
© 1979 The Society of Thoracic Surgeons

---

Articles

The Importance of Myocardial Protection in Combined Aortic Valve Replacement and Myocardial Revascularization

From the Section of Cardiothoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510.

^* Address reprint requests to Dr. Laks, Yale University School of Medicine, Section of Cardiothoracic Surgery, 333 Cedar St, New Haven, CT 06510.

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 (<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 < 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.

This article has been cited by other articles:

				W. C. Nugent, R. M. Weintraub, R. L. Thurer, and F. H. Levine Aortic Valve Replacement and Coronary Bypass in Patients with Severe Stenosis of the Left Main Coronary Artery Ann. Thorac. Surg., May 1, 1983; 35(5): S0003497510604377 - S0003497510604377. [Abstract] [PDF]

				H. B. Barner, G. C. Kaiser, J. E. Codd, D. H. Tyras, D. Glenn Pennington, H. Laks, and V. L. Willman Clinical Experience with Cold Blood as the Vehicle for Hypothermic Potassium Cardioplegia Ann. Thorac. Surg., March 1, 1980; 29(3): 224 - 227. [Abstract] [PDF]