[Coronary artery bypass grafting in patients with poor left ventricular function using retrograde continuous cold blood cardioplegia].
Patients with poor left ventricular function or those requiring urgent surgery may have more extensive ischemic myocardial injury if myocardial preservation is incomplete. We have performed coronary artery bypass grafting (CABG) aimed at complete revascularization in such cases using RC-CBCP, which is considered more effective on myocardial preservation during aortic cross-clamping in particular to protect ischemic area distal to severe coronary artery stenosis or obstruction. In the present study, in 25 patients with poor left ventricular function (left ventricular ejection fraction; LVEF less than or equal to 0.3) including 10 patients who required urgent surgery, the operative results were evaluated. All the distal and proximal anastomoses of grafts (average 2.5 grafts) were completed during one aortic cross-clamping using RC-CBCP, therefore graft flow was obtained immediately after release of the aortic clamping. Though this method required 142 minutes of a mean aortic cross-clamping time, myocardial protection was considered to be preferable judging from postoperative isoenzymatic evaluation and improved ventricular function. Fifteen patients with elective CABG were all alive and restored to NYHA class I to II. Among 10 patients requiring urgent CABG, 4 patients with acute myocardial infarction died but others were restored to NYHA class I to II. We conclude that it is important to aim at complete coronary revascularization in patients with poor left ventricular function and RC-CBCP achieves more effective myocardial protection during CABG in the patients.
Higami
T
T
Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan.
Ogawa
K
K
Asada
T
T
Mukohara
N
N
Nishiwaki
M
M
Sugimoto
T
T
Okada
K
K
Kawamura
T
T
D000328:Adult; D000368:Aged; D001769:Blood; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D006324:Heart Arrest, Induced / Q000379:methods; D006801:Humans; D007036:Hypothermia, Induced; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D016277:Ventricular Function, Left