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Postoperative myocardial ischemia in thoracic aortic aneurysms
S Sasaki1, K Yasuda, S Nanzaki
1Department of Cardiovascular Surgery, Hokkaido University Hospital, Sapporo, Japan. sasakish@med.hokudai.ac.jp
The Journal of Cardiovascular Surgery
|June 9, 2001
Summary
Total cardiopulmonary bypass use predicts myocardial ischemia in thoracic aortic aneurysm surgery. This finding may inform prophylactic vasodilator use in at-risk patients.
Area of Science:
- Cardiology
- Thoracic Surgery
- Intensive Care Medicine
Background:
- Thoracic aortic aneurysm surgery carries risks, including postoperative myocardial ischemia.
- Identifying predictors of ischemia is crucial for non-coronary risk patients undergoing these procedures.
Purpose of the Study:
- To determine the incidence and predictors of myocardial ischemia in patients undergoing thoracic aortic aneurysm repair.
- To evaluate the role of perioperative factors in the development of ischemia.
Main Methods:
- A prospective, observational study involving 20 patients without prior ischemic heart disease.
- Patients underwent elective surgical repair of thoracic or thoracoabdominal aortic aneurysms.
- Myocardial ischemia was monitored using ECG criteria; coronary vasodilators were administered as needed.
Main Results:
- Eleven patients (55%) developed myocardial ischemia.
- Total cardiopulmonary bypass was identified as the sole significant predictor of myocardial ischemia (p<0.01).
- Other factors like cardiac index and hypertension showed univariate but not multivariate significance.
Conclusions:
- Total cardiopulmonary bypass is a significant predictor of perioperative myocardial ischemia in thoracic aortic aneurysm surgery.
- Systemic ischemia-reperfusion and subsequent cytokine production may contribute to ischemia.
- Prophylactic coronary vasodilator use warrants further investigation in this patient population.