| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 230-237, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LI Bonchek, MW Burlingame, BE Vazales, EF Lundy and CJ Gassmann
Although some surgeons still prefer noncardioplegic coronary bypass, most
surgeons are skeptical of its suitability for high-risk patients. We
analyzed the first 3000 patients who had primary coronary bypass without
cardioplegia since our program's inception. Patients with reoperations,
valve operations, or carotid endarterectomies were excluded. Multivariate
predictors of operative death included age, sex, left ventricular
dysfunction, preoperative intraaortic balloon pumping, and urgency of
operation. Eight hundred seventy-nine patients (29%) were more than 70
years of age; 795 (27%) were female; 290 (9.7%) had an ejection fraction
less than 0.30, and another 77 (2.6%) had left ventricular aneurysms; 196
(6.5%) had an acute myocardial infarction, and another 397 (13%) had a
myocardial infarction less than 1 week preoperatively; 917 (31%) had rest
pain in the hospital (preinfarction angina). Only 790 (26%) had elective
operations. The overall operative mortality rate was 1.47% (44/3000): The
mortality rate for elective operations was 0.5% (4/790); urgent 1.7%
(28/1687); emergency 2.3% (12/523). In patients with an ejection fraction
less than 0.30 the mortality rate was 6.2% (18/290); with age more than 70
years, it was 3.9% (34 of 879); with acute myocardial infarction it was
3.1% (6/196); and with left ventricular aneurysmectomy it was 1.3% (1/77).
Inotropic support after leaving the operating room was needed in 6.6% (199
patients), and 1% (30 patients) required new intraaortic balloon pumping
postoperatively (two of these 30 patients died). These results provide
reassurance that noncardioplegic coronary artery bypass grafting provides
excellent myocardial protection and operating conditions for primary
coronary bypass and is particularly suitable for high-risk patients.
ARTICLES
Applicability of noncardioplegic coronary bypass to high-risk patients. Selection of patients, technique, and clinical experience in 3000 patients
Lancaster General Hospital, Pa.
This article has been cited by other articles:
|
|
 |
|
  R. M. Mentzer Jr, M. S. Jahania, and R. D. Lasley Myocardial Protection Card. Surg. Adult, January 1, 2008; 3(2008): 443 - 464. [Full Text]
|
|
|
|
 |
|
 M. Codispoti, T. Sundaramoorthi, R. A. Saad, A. Reid, C. Sinclair, and P. Mankad Optimal myocardial protection strategy for coronary artery bypass grafting without cardioplegia: prospective randomised trial Interactive CardioVascular and Thoracic Surgery, June 1, 2006; 5(3): 217 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Mishra Fibrillatory arrest technique: is it worth tasting the old wine in new bottle? Eur. J. Cardiothorac. Surg., May 1, 2006; 29(5): 860 - 860. [Full Text] [PDF]
|
|
|
|
|
|
M. Fujii and D. J. Chambers Myocardial protection with intermittent cross-clamp fibrillation: does preconditioning play a role? Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 821 - 831. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Fujii, M. Avkiran, and D. J Chambers Experimental studies on myocardial protection with intermittent cross-clamp fibrillation: additive effect of the sodium-hydrogen exchanger inhibitor, cariporide Ann. Thorac. Surg., April 1, 2004; 77(4): 1398 - 1407. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Alex, V. P. Rao, A. R.J. Cale, S. C. Griffin, M. E. Cowen, and L. Guvendik Surgical nurse assistants in cardiac surgery: a UK trainee's perspective Eur. J. Cardiothorac. Surg., January 1, 2004; 25(1): 111 - 115. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. I. Bonchek Non-cardioplegic coronary bypass is effective, teachable, and still widely used: letter 1 Ann. Thorac. Surg., August 1, 2003; 76(2): 660 - 661. [Full Text] [PDF]
|
|
|
|
|
|
G. Kleikamp, A. Maleszka, N. Reiss, B. Stuttgen, and R. Korfer Determinants of mid- and long-term results in patients after surgical revascularization for ischemic cardiomyopathy Ann. Thorac. Surg., May 1, 2003; 75(5): 1406 - 1412. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D J Wheatley Protecting the damaged heart during coronary surgery Heart, April 1, 2003; 89(4): 367 - 368. [Full Text] [PDF]
|
|
|
|
|
|
P E Antunes, J M F. de Oliveira, and M J Antunes Coronary surgery with non-cardioplegic methods in patients with advanced left ventricular dysfunction: immediate and long term results Heart, April 1, 2003; 89(4): 427 - 431. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Mentzer Jr., M. S. Jahania, and R. D. Lasley Myocardial Protection Card. Surg. Adult, January 1, 2003; 2(2003): 413 - 438. [Full Text]
|
|
|
|
 |
|
 L. I. Bonchek Off-pump coronary bypass: Is it for everyone? J. Thorac. Cardiovasc. Surg., September 1, 2002; 124(3): 431 - 434. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Dilip, M. H Rao, A. Chandra, M Sanjeeva Rao, D. Rajasekhar, S. V. Prasad, and A. Mohan Coronary Artery Bypass in Patients With Severe Left Ventricular Dysfunction Asian Cardiovasc Thorac Ann, September 1, 2002; 10(3): 211 - 214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Bessho and D. J. Chambers Myocardial protection with oxygenated esmolol cardioplegia during prolonged normothermic ischemia in the rat J. Thorac. Cardiovasc. Surg., August 1, 2002; 124(2): 340 - 351. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. I. Bonchek, D. van Dijk, P. P.T. de Jaegere, E. W.L. Jansen, H. M. Nathoe, J. C. Diephuis, C. Borst, E. Buskens, D. E. Grobbee, A. P. Nierich, et al. Off-Pump Versus On-Pump Coronary Bypass Surgery * Response Circulation, June 25, 2002; 105 (25): e198 - e198. [Full Text] [PDF]
|
|
|
|
|
|
L. Raco, E. Mills, and R. J.W. Millner Isolated myocardial revascularization with intermittent aortic cross-clamping: experience with 800 cases Ann. Thorac. Surg., May 1, 2002; 73(5): 1436 - 1439. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Bessho and D. J. Chambers Myocardial protection: The efficacy of an ultra-short-acting {beta}-blocker, esmolol, as a cardioplegic agent J. Thorac. Cardiovasc. Surg., November 1, 2001; 122(5): 993 - 1003. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Sunderdiek, P. Feindt, and E. Gams Aortocoronary bypass grafting: a comparison of HTK cardioplegia vs. intermittent aortic cross-clamping Eur. J. Cardiothorac. Surg., October 1, 2000; 18(4): 393 - 399. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Bessho and D. J. Chambers Experimental study of intermittent crossclamping with fibrillation and myocardial protection: Reduced injury from shorter cumulative ischemia or intrinsic protective effect? J. Thorac. Cardiovasc. Surg., September 1, 2000; 120(3): 528 - 537. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Wong, S. Vendargon, C. G. Lim, P. S. Wong, S. Vendargon, and C. G. Lim Coronary Artery Bypass Surgery Without Cardioplegia: Early Results Asian Cardiovasc Thorac Ann, June 1, 2000; 8(2): 103 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Musumeci, M. Feccia, P. A. MacCarthy, G. R. Ellis, L. Mammana, F. Brinn, and W. J. Penny Prospective randomized trial of single clamp technique versus intermittent ischaemic arrest: myocardial and neurological outcome Eur. J. Cardiothorac. Surg., June 1, 1999; 13(6): 702 - 709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. Liu, O. Valencia, T. Treasure, and A. J. Murday Cold blood cardioplegia or intermittent cross-clamping in coronary artery bypass grafting? Ann. Thorac. Surg., August 1, 1998; 66(2): 462 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. P. Perrault, P. Menasche, A. Bel, T. de Chaumaray, J. Peynet, A. Mondry, P. Olivero, R. Emanoil-Ravier, and J.-M. Moalic ISCHEMIC PRECONDITIONING IN CARDIAC SURGERY: A WORD OF CAUTION J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1378 - 1386. [Abstract] [Full Text]
|
|
|
|
|
|
D. P. Taggart, C. Atari, P. Wong, E. A. Paul, and J. E. Wright APPLICABILITY OF INTERMITTENT GLOBAL ISCHEMIA FOR REPEAT CORONARY ARTERY OPERATIONS J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 501 - 507. [Abstract] [Full Text]
|
|
|
|
|
|
M. Galinanes, V. Argano, and D. J. Hearse Can Ischemic Preconditioning Ensure Optimal Myocardial Protection When Delivery of Cardioplegia Is Impaired? Circulation, November 1, 1995; 92(9): 389 - 394. [Abstract] [Full Text]
|
|
|
|
|
|
A. S. Abd-Elfattah, M. Ding, and A. S. Wechsler INTERMITTENT AORTIC CROSSCLAMPING PREVENTS CUMULATIVE ADENOSINE TRIPHOSPHATE DEPLETION, VENTRICULAR FIBRILLATION, AND DYSFUNCTION (STUNNING): IS IT PRECONDITIONING? J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 328 - 339. [Abstract] [Full Text]
|
|
|
|
|
|
W. R. Chitwood Jr and C. L. Wixon Update in Myocardial Protection Ann. Thorac. Surg., January 1, 1995; 59(1): 253 - 254. [Full Text]
|
|
|
|
 |
|
 P. Hornick Carotid artery disease and myocardial revascularization Perfusion, January 1, 1994; 9(5): 309 - 317. [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
