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The Annals of Thoracic Surgery, Vol 54, 1065-1070, Copyright © 1992 by The Society of Thoracic Surgeons
MS Sweeney and OH Frazier
Although advances in both the technology of artificial oxygenation and our
understanding of myocardial preservation have made aortocoronary bypass
operations safer, clinical settings remain where even these improvements
have limited efficacy. We have recently treated 43 severely ill patients
with aortocoronary bypass, using a ventricular assist device for
intraoperative hemodynamic support and ventricular decompression. For 34 of
the patients, preoperative ejection fractions (multigated acquisition)
ranged from 0.12 to 0.28 (average, 0.22); 6 patients manifested cardiogenic
shock preoperatively, and emergency operations precluded multigated
acquisition studies. Twenty-nine patients had preoperative evidence of
congestive heart failure, 10 had a prior bypass operation, 9 had major
chronic obstructive pulmonary disease, and 2 were Jehovah's Witnesses. The
operative technique involved minimal doses of heparin (1 to 1.5 mg/kg), no
cardioplegia, and no cardiopulmonary bypass. Revascularization was
accomplished on beating, nonworking hearts, with right (40 of 43) and left
(43 of 43) ventricles supported by Nimbus Hemopumps (4 of 43) or
Bio-Medicus centrifugal ventricular assist devices for an average of 112
minutes. In each case, the patient's lungs were used as the oxygenator. An
average of 3.7 bypass grafts per patient were constructed. The left
internal mammary artery was used in 41 patients, whereas at least one
coronary endarterectomy was required in 20. Six patients had concomitant
placement of an automatic implantable cardioverter defibrillator. Two
patients (4.6%) died: 1 (with preoperative cardiogenic shock) of low
cardiac output on postoperative day 1, and 1 of a severe neurologic deficit
on day 8. Follow-up ranged from 2 to 18 months (average, 8.9 months), with
all survivors demonstrating improvement in cardiac function in both the
early and late postoperative periods.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Device-supported myocardial revascularization: safe help for sick hearts
Department of Thoracic and Cardiovascular Surgery, University of Texas Medical School, Houston 77030.
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