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The Journal of Thoracic and Cardiovascular Surgery, Vol 81, 69-84, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
AJ Roberts, SM Spies, JH Sanders, JM Moran, CJ Wilkinson, PR Lichtenthal, RL White and LL Michaelis
Forty patients who recently underwent coronary artery bypass graft (CABG)
operations had serial hemodynamic and scintigraphic studies. Multidose
hypothermic potassium crystalloid cardioplegia was used for myocardial
protection and newer techniques in anesthetic management and perioperative
patient care were also employed. The method of equilibrium cardiac gated
blood pool (GBP) scintigraphy was used to obtain perioperative changes in
global ejection fraction (EF) and regional wall motion (RWM). Ninety
percent of patients displayed a decrease in EF 2 hours postoperatively when
compared to their preoperative values. This change was also associated with
a fall in cardiac index (CI) and left ventricular stroke work index
(LVSWI). Twenty-four hours postoperatively, EF and CI recovered to
preoperative levels, but LVSWI remained depressed. Seven days
postoperatively, global EF had improved to a value greater than the
preoperative one (50% +/- 3% versus 57% +/- 4%, p < 0.05). Perioperative
changes in RWM followed the same pattern as EF, but recovery in this index
of regional contractility was faster than EF, since maximal improvement was
observed 24 hours postoperatively. Thus transient left ventricular
dysfunction is common immediately after CABG, but recent advances in
myocardial protection and perioperative management are associated with
short-term increases in regional and global left ventricular function
documented by noninvasive GBP imaging.
ARTICLES
Serial assessment of left ventricular performance following coronary artery bypass grafting. Early postoperative results with myocardial protection afforded by multidose hypothermic potassium crystalloid cardioplegia
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