[Cardiogenic shock. Surgical reperfusion and myocardial revascularization]

Emergency coronary bypass for cardiogenic shock has been associated with a high operative mortality. From February 1986 through October 1989, 40 patients with acute myocardial infarction were operated. Ten pts (25%) were in shock despite intensive treatment (intra-aortic balloon pump in 4, catecholamines in 10). Seven pts. required cardiopulmonary resuscitation before operations. After operations 66% of the patients required catecholamine support and 60% were treated with intra-aortic balloon pump. There were three (30%) hospital deaths (one in the operating room due to acute cardiac failure). Follow-up (100%),(mean 26 months) revealed one late death--39 months after operations. In functional class I were 2 patients, II--one, and III--two pts. One pt is in group IV (transplant candidate). Myocardial infarction complicated by cardiogenic shock can produce a mortality rate in excess of 85%. Contemporary medical management has had little effect on mortality, hence effective surgical therapy has evolved for this lesion.