Studies on prolonged acute regional ischemia. VI. Myocardial infarction with left ventricular power failure

A medical/surgical emergency requiring urgent revascularization with maximal protection of remote muscle

B. S. Allen, Eliot Rosenkranz, G. D. Buckberg, H. Davtyan, H. Laks, J. Tillisch, D. C. Drinkwater

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Eighty consecutive patients receiving maximum inotropic and intraaortic balloon support underwent emergency coronary artery bypass grafting 3.4 ± 1 days (mean ± standard error) after infarction for severe left ventricular power failure (stroke work index < 25 gm-m, left atrial pressure > 20 mm Hg). All underwent induction of cardioplegia with a 37°C glutamate/aspartate blood cardioplegic solution, multidose cold (4°C) replenishment, and warm reperfusate. Viable areas were grafted first to ensure cardioplegic distribution. Left ventricular power failure was reversed in 94% of patients; 75 of 80 patients had discontinuation of inotropic drugs and intraaortic balloon support. The early mortality rate (< 30 days) was only 7% (3/45) with early operation (< 18 hours) and rose to 31% (11/35, p < 0.05) if operation was delayed more than 18 hours. Six of 14 early deaths were due to progression of preoperative organ failure despite reversal of shock. Eighteen of 66 early survivors died of end-stage heart failure (21/80), a 26% late mortality rate. Nonsurvivors (early and late) had a higher incidence of extending versus evolving infarction (33/64 versus 2/16, p < 0.05), a longer delay from shock to operation (11/45 versus 24/35, p < 0.05), more preoperative organ failure (9/9 versus 26/71, p < 0.05), and a greater incidence of previous infarction (22/43 versus 13/37, p > 0.05). Thirty of 45 late survivors (67%) remain physically active. We conclude that left ventricular power failure should be considered a medical/surgical emergency that necessitates prompt angiography and can be reversed in selected patients. Postoperative mortality (early and late) is due principally to delay of operation leading to progression of preoperative organ failure of progression of underlying cardiac disease if infarction becomes established.

Original languageEnglish
Pages (from-to)691-703
Number of pages13
JournalJournal of Thoracic and Cardiovascular Surgery
Volume98
Issue number5 I
StatePublished - Jan 1 1989
Externally publishedYes

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Emergencies
Ischemia
Myocardial Infarction
Muscles
Infarction
Cardioplegic Solutions
Induced Heart Arrest
Mortality
Aspartic Acid
Coronary Artery Bypass
Survivors
Glutamic Acid
Heart Diseases
Angiography
Stroke
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Studies on prolonged acute regional ischemia. VI. Myocardial infarction with left ventricular power failure : A medical/surgical emergency requiring urgent revascularization with maximal protection of remote muscle. / Allen, B. S.; Rosenkranz, Eliot; Buckberg, G. D.; Davtyan, H.; Laks, H.; Tillisch, J.; Drinkwater, D. C.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 98, No. 5 I, 01.01.1989, p. 691-703.

Research output: Contribution to journalArticle

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