| Autor: |
Cukingnan, Ramon A., Greg Brown, B., Wittig, John H., Carey, Joseph S. |
| Zdroj: |
Journal of Thoracic and Cardiovascular Surgery; May 1982, Vol. 83 Issue: 5 p711-717, 7p |
| Abstrakt: |
The hemodynamic effect of myocardial revascularization with saphenous vein grafts (mean 3.3 per patient) was analyzed I year after operation in 111 patients. Operations were performed using one continuous period of aortic cross-clamping with hyperkalemic cardioplegia for distal anastomoses in 84% of patients; 16% had arrest with topical and systemic hypothermia for myocardial protection. Group I (N = 18) had normal ventricles (ejection fraction [EF] ≥ 50%; left ventricular end-diastolic pressure [LVEDP] ≤ 12 torr); Group II (N = 64) had ischemic ventricles (EF ≥ 50%, LVEDP > 13 torr); and Group III (N = 30) had abnormal ventricles (EF < 50%, LVEDP > 13 torr). Hemodynamic measurements were obtained before and 1 year after operation. Fifteen of 18 patients (83%) in Group I did not show significant hemodynamic changes, but in three EF decreased by ≥ 10% and LVEDP increased by ≥ 10% over preoperative levels. In Group II, EF was unchanged or slightly better in 89% (57/64) and worse in seven patients. Improvement in cardiac index (p < 0.01) and LVEDP (p < 0.001) was significant. Worsening of EF in 10 of 82 patients in Groups I and II was attributed to graft closure and/or poor myocardial protection. In Group III, significant improvement in cardiac index (p < 0.001), EF (p < 0.001), and LVEDP (p < 0.01) was also noted. A subset of nine patients with EF ≤ 35% showed postoperative improvement in 56%. Of the remaining 20 patients with an EF of > 35% to <50%, half had ≥ 20% improvement in postoperative EF. Operative mortality was 3.3% (1/30) for Group III. Late mortality was 1.5% (1/64) for Group II and 10% (3/29) for Group III. Significant improvement was noted postoperatively in 67% (57/85) of all patients who had preoperative treadmill tests (p < 0.001). This study shows that myocardial revascularization significantly improved left ventricular performance in most patients with ischemic and abnormal ventricles. Previous studies that fail to show improvement may be related to incomplete revascularization and/or poor myocardial preservation. These data, therefore, justify the need for revascularization of the impaired ventricle. |
| Databáze: |
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