The Annals of Thoracic Surgery, Vol 33, 132-138, Copyright © 1982 by The Society of Thoracic Surgeons
Delayed operative intervention in cardiogenic shock after myocardial infarction
GL Hines and M Mohtashemi
In a four-year period, 45 patients underwent counterpulsation for
cardiogenic shock following myocardial infarction. Of these patients, 27
underwent angiography. Fifteen of them were not considered to be operative
candidates because angiography demonstrated only single- vessel disease or
diffuse distal coronary artery disease. Twelve patients were candidates for
operation and were divided into three subgroups depending on the time of
surgical intervention. One patient (Group 1) deteriorated while on
counterpulsation, and underwent urgent angiography and operative
intervention within 24 hours of balloon insertion. He is now in New York
Heart Association (NYHA) Functional Class I. Group 2 consisted of 7
patients whose condition stabilized with use of the balloon but who could
not be weaned. All underwent angiography from 7 to 14 days after insertion
of the balloon. One patient died suddenly prior to operation. Six patients
underwent coronary bypass from 8 to 21 days after balloon insertion. Five
survived and are in NYHA Class II or III. Four patients were able to be
weaned after angiography (Group 3). All had triple-vessel disease.
Operation was undertaken six to eight weeks after infarction to treat
persistent congestive heart failure or angina, or to improve chances of
long-term survival. Two patients in this group survived. Our experience
demonstrates that delayed intervention is an acceptable alternative to
urgent operation.
