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Myocardial damage in combined valvular and coronary bypass surgery

S J Rossiter, H N Hultgren, J C Kosek

    Circulation
    |August 1, 1975
    PubMed

    Insights

    Patients undergoing aortic valve replacement plus aortocoronary vein grafts (AVR + CABG) face higher risks of perioperative myocardial infarction (MI). Minimizing aortic cross-clamp and fibrillation times is crucial for reducing MI risk in these patients.

    Area of Science:

    • Cardiology
    • Cardiac Surgery
    • Cardiovascular Research

    Background:

    • Perioperative myocardial infarction (MI) is a significant complication following cardiac surgery.
    • The risk of MI may vary depending on the type of cardiac procedure performed.
    • Combined aortic valve replacement and aortocoronary vein grafts (AVR + CABG) present a unique surgical challenge.

    Purpose of the Study:

    • To determine the incidence of perioperative myocardial infarction (MI) and acute ischemic injury in patients undergoing AVR + CABG compared to other cardiac procedures.
    • To investigate the correlation between perioperative MI and factors such as aortic cross-clamp time, fibrillation time, and left ventricular hypertrophy.
    • To identify risk factors associated with increased MI incidence in the AVR + CABG patient cohort.

    Main Methods:

    • Retrospective analysis of 44 patients undergoing AVR + CABG and 22 patients undergoing mitral valve repair or replacement plus aortocoronary vein grafts (MVR + CABG).
    • Comparison of MI rates with historical data from isolated valve replacement and isolated CABG procedures.
    • Correlation of MI incidence with intraoperative variables including aortic cross-clamp time and fibrillation time.
    • Inclusion of left ventricular biopsy data in selected cases to assess myocardial damage.

    Main Results:

    • The incidence of perioperative MI was 21% in the AVR + CABG group, significantly higher than the 5% in the MVR + CABG group.
    • MI rates for isolated valve replacement and isolated CABG were 7% and 14%, respectively.
    • All patients (100%) in the AVR + CABG group with combined aortic cross-clamp and fibrillation times exceeding 120 minutes experienced MI.
    • Patients undergoing combined AVR + CABG demonstrated a substantially greater risk of perioperative myocardial damage.

    Conclusions:

    • Combined AVR + CABG procedures are associated with a significantly higher risk of perioperative myocardial infarction compared to MVR + CABG, isolated valve replacement, or isolated CABG.
    • Prolonged aortic cross-clamp time and fibrillation time are critical risk factors for perioperative MI in AVR + CABG patients.
    • Strategies to minimize aortic cross-clamp and fibrillation times should be implemented to reduce myocardial damage in patients undergoing AVR + CABG.

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