PMID: 306231May 1, 1978

Criteria for operability and reduction of surgical mortality in patients with severe left ventricular ischemia and dysfunction

The Annals of Thoracic Surgery
E L JonesC R Hatcher

Abstract

A series of 188 patients who were operated on for left ventricular ischemia and dysfunction is presented. Angina was a prominent symptom in all patients, and a history of congestive heart failure could be elicited in 20%. Mean ejection fraction for the series was 0.35, with 67% having an ejection fraction of 0.35 or less 24%, 0.20 or less. Complete revascularization was accomplished whenever possible; more than 70% of the patients had triple-vessel disease, and single bypass was performed infrequently (5%). Factors thought to be important in achieving a low operative mortality (2.1%) were: precise prebypass monitoring, particularly with the V5 precordial lead; maintaining a low rate-pressure product (less than 12,000) prior to bypass; myocardial preservation with cold hyperkalemic or hyperkalemic-hyperosmolar solution; and careful titration of inotropic and vasodilator drugs. Inotropic drugs and intraaortic balloon pumping were used frequently in this series. The late mortality was 4.3%. Angina was completely relieved or improved in 94% of the patients. Those having a history of congestive heart failure had an increased late mortality rate, four times that of the entire series.

References

Jan 1, 1978·Cleveland Clinic Quarterly·L Campeau
Jan 1, 1978·Cleveland Clinic Quarterly·R J HallA G Gray
Sep 22, 1977·The New England Journal of Medicine·E Braunwald
Nov 23, 1976·The American Journal of Cardiology·E L JonesC R Hatcher
Feb 11, 1976·The Annals of Thoracic Surgery·W Seybold-EptingD A Cooley
Dec 1, 1972·Archives of Surgery·H N OldhamD C Sabiston
Jul 1, 1973·Circulation·J J CollinsR Gorlin
Feb 1, 1974·The American Journal of Cardiology·J S WebsterG Rincon
Feb 1, 1974·The American Journal of Cardiology·P F CohnR Gorlin
Jun 1, 1972·Annals of Surgery·G C MorrisW Stelter
Apr 1, 1971·Archives of Surgery·G J ReulF M Sandiford
Sep 1, 1983·The American Journal of Cardiology·D B PryorR A Rosati
Dec 1, 1958·Journal of Chronic Diseases·S J CUTLER, F EDERER
Aug 2, 2008·Asian Cardiovascular & Thoracic Annals·Seyed-Ahmad HassantashHaleh Afshar

Citations

Jun 1, 1984·Journal of the American College of Cardiology·P KuanM H Ellestad
Nov 1, 1983·Canadian Anaesthetists' Society Journal·P M CruchleyD Finucane
Sep 1, 1993·The Annals of Thoracic Surgery·C A MilanoP Van Trigt
Jun 1, 1981·American Journal of Surgery·F D LoopL R Golding
Jan 1, 1982·International Journal of Cardiology·E L JonesC R Hatcher
Jun 1, 1981·American Journal of Surgery·D C MillerE L Alderman
Jan 1, 1981·American Heart Journal·F D LoopW L Proudfit
Jan 1, 1984·The Annals of Thoracic Surgery·D H TyrasV L Willman
Jan 6, 1999·The Annals of Thoracic Surgery·G D TrachiotisJ M Craver
Apr 1, 1981·The American Journal of Cardiology·W S KnappC R Hatcher
Nov 21, 2002·The Annals of Thoracic Surgery·John Alfred CarrNorman A Silverman
Dec 1, 1982·The Australian and New Zealand Journal of Surgery·R W BuntonP J Molloy
Mar 8, 2003·International Journal of Cardiovascular Interventions·Ron JG PetersJaap J Bredee

Related Concepts

Angina Pectoris
Coronary Artery Bypass Surgery
Cardiac Output
Cardiopulmonary Bypass
Coronary Heart Disease
Cardiac Catheterization Procedures
Myocardial Failure
Left Ventricular Structure
Myocardial Infarction
Internal Mammary Artery Implantation

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