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Event-free survival following nonemergency myocardial revascularization during hypothermic fibrillatory arrest
Insights
Hypothermic fibrillatory arrest is effective for myocardial revascularization, showing excellent long-term survival and event-free rates. This technique offers superior myocardial preservation during coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiology
Background:
- Hypothermic fibrillatory arrest is a technique used during myocardial revascularization.
- Assessing the long-term results of this method is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the late results of hypothermic fibrillatory arrest in patients undergoing coronary artery grafting.
- To determine event-free survival rates following this procedure.
Main Methods:
- A consecutive series of 1,000 patients undergoing nonemergency coronary artery grafting were studied.
- Data collected included hospital mortality, perioperative myocardial infarction, and long-term follow-up events.
- Actuarial survival and event-free rates were calculated at five years.
Main Results:
- Hospital mortality was 0.4%, and perioperative myocardial infarction rate was 1.8%.
- Five-year actuarial survival was 91.6%.
- Excellent five-year event-free rates were observed for myocardial infarction (97.7%), percutaneous transluminal coronary angioplasty (99.4%), and reoperative revascularization (99.5%).
Conclusions:
- Hypothermic fibrillatory arrest is effective for myocardial preservation during coronary revascularization.
- Combined with complete revascularization, it yields excellent event-free survival.
- The technique demonstrates favorable long-term outcomes for patients undergoing coronary artery bypass grafting.
Abstract:
To better assess the late results of hypothermic fibrillatory arrest during myocardial revascularization, 1,000 consecutive patients having nonemergency coronary artery grafting during hypothermic fibrillatory arrest from August, 1979, through November, 1984, were studied to determine event-free survival. Hospital mortality was 0.4% and the rate of perioperative myocardial infarction, 1.8%. At follow-up (mean, 30.5 months), 11 patients had sustained an interval nonfatal myocardial infarction, 3 had had percutaneous angioplasty, and 2 had undergone reoperative revascularization. Actuarial survival at five years was 91.6 +/- 2.0%. Actuarial event-free rates at five years were 97.7 +/- 0.8% for myocardial infarction, 99.4 +/- 0.4% for percutaneous transluminal coronary angioplasty, 99.5 +/- 0.4% for reoperative revascularization, and 88.6 +/- 2.2% for all combined morbidity and mortality. Among the 122 patients meeting randomizable admission criteria of the Coronary Artery Surgery Study, there were no operative deaths and no perioperative infarctions, and the actuarial survival was 97.5% at five years. Hypothermic fibrillatory arrest is effective for myocardial preservation during coronary revascularization and when combined with complete revascularization, yields excellent event-free survival.