title: Coronary operations in patients with spinal cord injury.
abstract: BACKGROUND
  The risk of heart disease in patients with spinal cord injury is similar to that in the general population. The physiologic derangements raise special problems in patients with SCI having coronary operations.
  
  
  METHODS
  From January 1980 to May 1995, we performed coronary artery bypass procedures on 20 patients with SCI; 4 were tetraplegic and the remainder were paraplegic. The indication for operation was angina: unstable (13), exertional (4), or postinfarctional (3). Bowel and bladder care was given immediately before operation; operating room tables were double padded and a pelvic wrap was used to protect the back. Electric wheelchairs were used for early mobilization.
  
  
  RESULTS
  Vasomotor instability from cardiopulmonary bypass was not present in patients with SCI. Pharmacologic support was required in the operating room by 4 patients for low vascular resistance, but in only one case in the intensive care unit. One patient required ventilation support for more than 24 hours. All patients were able to cough effectively. No thoracic wound complications occurred. There were three operative deaths, all in patients with multiple risk factors. The acute hospital stay averaged 9.3 days; patients were then transferred to an SCI unit for rehabilitation, were upper-extremity weight bearing was restricted for 2 to 4 weeks.
  
  
  CONCLUSIONS
  Patients should not be denied coronary artery bypass procedures because of an SCI, but their special needs must be managed properly.
authors.affiliation: Department of Surgery, The University of Tennessee, College of Medicine, Memphis, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Walker
authors.forename: B J
authors.initials: BJ
authors.lastname: Evans
authors.forename: J W
authors.initials: JW
authors.lastname: Pate
authors.forename: D S
authors.initials: DS
authors.lastname: Weiman
authors.forename: J C
authors.initials: JC
authors.lastname: Riddle
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000601:surgery*; D011182:Postoperative Care; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome