Experience with emergency cardiac surgery following institution of percutaneous cardiopulmonary support.
Between August 1992 and February 1998, 43 patients were treated with percutaneous cardiopulmonary support (PCPS) in our institution, and 8 of them subsequently required emergency cardiac surgery. There were 3 males and 5 females with a mean age of 63 years (range, 37 to 81 years). The etiology of shock in these 8 patients was acute myocardial infarction in 3, postinfarction left ventricular (LV) free wall rupture in 1, postinfarction ventricular septal perforation (VSP) in 1, LV free wall rupture and VSP in 1, and fatal arrhythmia due to severe aortic valvular disease in 2. The mean time interval from the onset of cardiogenic shock to the institution of PCPS was 77 min (range, 18 to 183 min). The mean time interval from the institution of PCPS until surgery was 145 min (range, 40 to 603 min). The surgical procedures were coronary artery bypass grafting (CABG) in 3 patients, closure of the LV rupture and/or closure of VSP in 3, and aortic valve replacement in 2. Six patients were weaned from PCPS, and 2 patients were discharged from the hospital (discharge rate, 25%). Although the results of emergency cardiac surgery following PCPS still are not satisfactory, we continue to apply PCPS and perform appropriate surgical procedures to improve the survival rate of the patients who would die without PCPS.
Department of Cardio-Vascular Surgery, Akane Foundation, Tsuchiya General Hospital, Hiroshima City, Japan.
N
N
Mitsui
T
T
Koyama
A
A
Marui
T
T
Mochizuki
Y
Y
Hayashi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D009202:Cardiomyopathies / Q000150:complications / Q000601:surgery; D001026:Coronary Artery Bypass; D004630:Emergencies; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000150:complications / Q000601:surgery; D006346:Heart Septum / Q000473:pathology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D010351:Patient Discharge; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000601:surgery