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The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 174-181, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
CW Akins
Hypothermic potassium cardioplegia has become the most popular technique
for myocardial preservation during coronary revascularization. However, an
older technique continues to yield comparable results with some potential
advantages. Myocardial preservation was achieved with systemic hypothermia
to 28 degrees C, pericardial cooling, elective ventricular fibrillation,
maintenance of systemic perfusion pressure between 80 and 100 mm Hg,
routine left ventricular venting, and local vessel isolation during distal
anastomoses without aortic occlusion. Proximal anastomoses were performed
prior to atrial cannulation and cardiopulmonary bypass. Nonemergency
isolated bypass grafting was performed in 500 consecutive patients, of whom
51% had had a prior myocardial infarction, 24% had unstable angina, and 21%
had left main coronary stenosis. Primary grafting was performed in 483
patients and reoperations in 17. The mean number of grafts per patient was
3.8. Perioperative myocardial infarction occurred in 1.8%. Hospital
mortality was 0.4%. Late follow- up was obtained for all survivors at a
mean postoperative interval of 17.8 months. All survivors were asymptomatic
or improved over their preoperative status. The 3 year actuarial survival
rate was 95.8%, equivalent to that for the matched general population. Of
287 male patients under age 65, 68.4% were working preoperatively and 69.5%
postoperatively. This technique provides results comparable to bypass
grafting with cardioplegia and may be useful when aortic occlusion or
administration of cardioplegic solutions is not desirable.
ARTICLES
Noncardioplegic myocardial preservation for coronary revascularization
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