Acute treatment of ST-segment-elevation myocardial infarction: is there a role for the cardiac surgeon?

The Annals of Thoracic Surgery
Christian HaglAxel Haverich

Abstract

Several attempts from single institutions to treat acute myocardial infarctions with bypass surgery never reached widespread acceptance in the cardiology and surgical community. Owing to a variety of new surgical techniques, this old dogma has to be reconsidered under the light of patient-adjusted optimal treatment algorithms. Between August 2002 and August 2007, 112 patients, mean age of 66 years (range, 41 to 85 years), underwent emergency coronary artery bypass grafting (untreatable or rejected by the referring cardiologists within 48 hours after onset of symptoms). Thirty-seven patients (33%) exhibited cardiogenic shock, and 18 (16%) had prior cardiopulmonary resuscitation. Preoperative support by intraaortic balloon pump was initiated in only 10%, and 65% had left main stem stenosis. All patients showed a significant elevation of cardiac markers (creatine kinase-MB) and ST-segment elevation. The mean number of grafts was 2.4 (range, 1 to 4). The cardiopulmonary bypass time ranged from 48 to 261 minutes. Intraaortic balloon pump for weaning from extracorporeal circulation was used in 42 patients (38%); 3 patients needed extracorporeal membrane oxygenation support. Postoperative complications included rethoracotomy for bleed...Continue Reading

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Citations

Jul 4, 2013·Journal of Cardiothoracic Surgery·Nawid KhaladjChristian Hagl
Dec 21, 2013·General Thoracic and Cardiovascular Surgery·Hiroyuki NishiYoshiki Sawa
Nov 13, 2010·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·T SchillingH A Katus
Nov 19, 2010·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·R BekeredjianA Haverich
Nov 26, 2009·The Annals of Thoracic Surgery·Rohinton J Morris
Jul 6, 2014·Interactive Cardiovascular and Thoracic Surgery·Sven PeterssNawid Khaladj
Feb 11, 2015·Journal of Interventional Cardiology·Atif N KhanShereif H Rezkalla
Jun 16, 2016·Texas Heart Institute Journal·Erin M SchumerMark S Slaughter
Mar 13, 2012·Hospital Practice·Arun KarunakaranRobert F Storey
May 18, 2021·The Journal of Thoracic and Cardiovascular Surgery·Sarah A Clark, Nicholas R Teman

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