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Coronary artery bypass without cardioplegia.
The Journal of Thoracic and Cardiovascular Surgery
|February 1, 1987
Summary
Intermittent aortic clamping offers excellent myocardial protection during coronary artery bypass surgery. This safe method avoids concerns associated with cardioplegic solutions, especially in complex cases.
Area of Science:
- Cardiac Surgery
- Cardiovascular Research
- Surgical Techniques
Background:
- Cardioplegic myocardial protection is standard for coronary artery bypass (CAB).
- Concerns exist regarding cardioplegic protection efficacy with occluded coronaries or internal mammary grafts.
Purpose of the Study:
- To evaluate the efficacy of intermittent aortic clamping with hypothermia for myocardial protection during coronary artery bypass.
- To assess outcomes in a large cohort of unselected patients undergoing coronary artery bypass.
Main Methods:
- 500 consecutive coronary artery bypass operations were performed using intermittent aortic clamping, left ventricular venting, and 30°C hypothermia.
- Patients included those with urgent/emergency operations, unstable angina, preinfarction angina, and evolving myocardial infarction.
Main Results:
- Low hospital mortality (1%) with no deaths attributed to poor myocardial protection.
- Minimal need for postoperative inotropic support (0.4%) or balloon pump (0.6%).
- Low perioperative infarction rate (3.6%) in a high-risk patient population (80% with acute coronary syndromes).
Conclusions:
- Intermittent ischemia provides excellent myocardial protection during coronary artery bypass.
- This technique is a simple, safe alternative to cardioplegia, particularly when graft patency is a concern.