title: Myocardial damage in combined valvular and coronary bypass surgery.
abstract: The incidence of perioperative myocardial infarction (MI) and acute ischemic injury was determined in 44 patients having aortic valve replacement plus aortocoronary vein grafts (AVR + CABG) and in 22 patients having mitral valve repair or replacement plus aortocoronary vein grafts (MVR + CABG). These data were correlated with aortic cross-clamp time, fibrillation time, presence of left ventricular hypertrophy, and, in selected cases, left ventricular biopsy. Perioperative MI occurred in 21% (9/44) of the AVR + CABG patients and 5% (1/22) of MVR + CABG patients. In contrast, the MI rate for isolated valve replacement was 7% (15/213), and for isolated CABG 14% (16/112). In the AVR + CABG group, 100% (5/5) of patients with combined cross-clamp and fibrillation times greater than 120 minutes suffered MI. These results indicate that patients with combined AVR + CABG are subject to substantially greater risk of perioperative myocardial damage than the other groups. Excessive aortic cross-clamp times and fibrillation plus aortic cross-clamp times should be avoided in AVR + CABG patients.
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001219:Aspartate Aminotransferases / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003327:Coronary Disease / Q000209:etiology*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008943:Mitral Valve / Q000601:surgery*; D009203:Myocardial Infarction / Q000209:etiology* / Q000473:pathology; D009206:Myocardium / Q000648:ultrastructure; D011183:Postoperative Complications; D013997:Time Factors
chemical_list: D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases