Experience with Emergency Aortocoronary Bypass Grafts in the Presence of Acute Myocardial Infarction

Abstract

In the past 18 months 15 patients have undergone emergency aortocoronary bypass grafts using saphenous vein in the presence of acute myocardial infarction. Eight patients were in a state of cardiogenic shock, and seven patients were having severe cardiac arrhythmias, persistent hypotension, or signs of extending infarction. There were three operative deaths, all of which occurred in the cardiogenic shock group of patients. One patient died three months after operation of a cerebrovascular accident. There are 11 surviving patients. One patient presently has angina, and one patient shows signs of left heart failure. The remaining patients are well at the present time. We feel that angiography and surgery early in the course of a complicated myocardial infarct should diminish the immediate risk of death from both pump failure and cardiac rupture. Controlled prospective studies are required to elucidate the timing and indications for operation.

Coronary Reperfusion in Primates SERIAL ELECTROCARDIOGRAPHIC AND HISTOLOGIC ASSESSMENT

“…The rapid increase in S-T elevation within 1-2 h after occlusion implies a rapidly increasing area of injured muscle, though irreversible muscle necrosis is concurrent, beginning probably within 20-30 min after occlusion (2,3). During this initial phase, however, the area of injury is increasing at a much faster rate than the area undergoing necrosis.…”

“…Experimental and clinical data have increasingly supported the concept of immediate reperfusion surgery for acute coronary occlusion with myocardial infarction (1)(2)(3)(4). Clinically, however, immediate reperfusion is often not possible, and the time interval between the onset of progressive infarction and potentially beneficial surgery has not been well defined.…”

Myocardial Revascularization After Acute Myocardial Infarction

“…Postoperative cardiac catheterization studies were performed in 13 These studies were repeated prior to patient discharge from the hosptial.…”

90. Dringliche Coronarchirurgie

“…In Kombination mit transluminaler Coronarangioplastik oder mit anschliegender Bypassversorgung sind auch die Langzeitresultate sehr gfinstig geworden [4,11], [1,9,15]. Betrachtet man Publikationen aus friiheren Zeitr~iumen, in denen Kollektive erfal3t werden, bei denen eine Selektion kaum vorgenommen wurde, so zeigt sich doch eine h6here Letalit/it [2,7,8,14,16,20]. Betrachtet man Publikationen aus friiheren Zeitr~iumen, in denen Kollektive erfal3t werden, bei denen eine Selektion kaum vorgenommen wurde, so zeigt sich doch eine h6here Letalit/it [2,7,8,14,16,20].…”