Left main coronary artery stenosis: hemodynamic monitoring to reduce mortality

A review of 20 consecutive patients with left main coronary artery stenosis operated on in 1976 indicated a general hemodynamic pattern characterized by systolic hypertension and an increase in heart rate that occurred early during the induction phase of anesthesia. From January through August, 1977, 28 patients with this stenotic condition were operated on with hemodynamic monitoring of left ventricular pressure and cardiac output by a Swan-Ganz catheter inserted before induction of anesthesia. Pharmacological interventions to optimize preload with volume, reduce afterload with nitroprusside or nitroglycerine, control heart rate with propranolol, and improve contractility with dopamine resulted in a decrease in mortality from 20% in Group 1 (1976) to 3.5% in Group 2 (1977). We conclude that control of systemic blood pressure, heart rate, and preload has notably reduced the mortality in this group of patients and that hemodynamic monitoring provides precise guidelines for therapeutic interventions.