[Surgical treatment of myocardial ischemia with cardiogenic shock]

We evaluated the results of surgical treatment of myocardial ischemia with cardiogenic shock in ten patients. Seven of 10 patients survived after surgery. Other three patients died of multiple organ failure (two patients) or severe left ventricular power failure (one patient). Two patients with previous infarction survived. Lesions in the group of survivors after surgery were left main trunk (LMT) disease in one patient, three vessel disease (3VD) in two, 2VD in two and 1VD in two patients. All nonsurvivors had LMT disease. Two patients died in whom preoperative electrocardiography (ECG) had shown Q wave. No significant difference in periods from onset to start of cardiopulmonary bypass (CPB) and from onset to recanalization was found between survivors and nonsurvivors. CPB time and aorta cross-clamp time in survivors were similar to those in nonsurvivors. At 24-hour after operation, pulmonary capillary wedge pressure in survivors showed significantly low value compared to that in nonsurvivors (12.8 +/- 3.9, 19.3 +/- 1.5 mmHg, respectively, p less than 0.05). Four patients out of seven survivors were in 1 of Forrester's classification, two in 2 and one in 3. Of three nonsurvivors, one were in 3 and two in 4. We conclude that mortality related to three risk factors: (1) LMT disease, (2) Q wave in preoperative ECG, and (3) hemodynamic state at 24-hour after operation.