Integrated Medical-Surgical Care in Acute Coronary Artery Disease Adv. Cardiol., vol. 15, pp. 140-141 (Karger, Basel 1975)
Coronary Bypass Graft for Stable Angina, Impending Myocardial Infarction and Acute Myocardial Infarction JOHN H. GANJI, RALPH BERG, jr., ROBERT W. KENDALL, GEORGE E. DUVOISIN and LLOYD W. RUDY
Since March of 1969, we have performed 1,000 consecutive cases of vein bypass graft. Valvular replacement or intracardiac surgery other than ventricular aneurysm resection is excluded from this study. The mortality for these 1,000 cases is 23, or 2.3010. Of these 1,000 cases, 151 were classified as impending myocardial infarction (instable angina). There have been 2 operative deaths in this group. Since April, 1970, we have undertaken emergency myocardial revascularization by saphenous vein technique on 51 patients, 48 male and 3 female patients, with an acute myocardial process manifested by chest pain lasting longer than 1 h, unrelieved by nitrate therapy and with ECG changes of acute injury. Diagnostic left heart catheterization with left ventricular (LV) angiography and selective angiography was performed on the average of 2 h from the onset of chest pain and the patient was revascularized on an average of 5 h from the onset of the chest pain. Of these 51 patients, 4 were in cardiogenic shock. One was placed on balloon assistance for several hours while the operating room was being prepared and immediately after surgery the balloon assistance was discontinued; the patient maintained a satisfactory blood pressure and made an uneventful recovery. The second patient was in profound shock and had multiple ventricular fibrillation. He was defibrillated 12 times and had an emergency temporary pacemaker implanted. This patient had a triple bypass graft performed and made a satisfactory recovery and left the hospital 10 days postoperatively. The remaining 2 patients were in cardiogenic shock. They both were operated upon after they had been in cardiogenic shock longer than 6 h. Both of these patients died.
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Thoracic and Cardiovascular Surgery, Spokane, Wash.
GANII/DuvOISIN
141
Author's address: JOHN H. GANlI, M.D., South Center Medical Building, Spokane, W A 99204 (USA)
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The mortality in this group of 51 patients is 4 %. 27 of these patients have been restudied, showing an average decrease in LV diastolic pressure from 19.6 to 14.4 mm Hg, and a graft potency rate of 93 %. This data suggests that emergency surgery done within 6 h of acute myocardial infarction may preserve some ventricular function in the face of acute myocardial process.
Coronary Bypass Graft for Stable Angina, Impending Myocardial Infarction and Acute Myocardial Infarction JOHN H. GANJI, RALPH BERG, jr., ROBERT W. KENDALL, GEORGE E. DUVOISIN and LLOYD W. RUDY
Since March of 1969, we have performed 1,000 consecutive cases of vein bypass graft. Valvular replacement or intracardiac surgery other than ventricular aneurysm resection is excluded from this study. The mortality for these 1,000 cases is 23, or 2.3010. Of these 1,000 cases, 151 were classified as impending myocardial infarction (instable angina). There have been 2 operative deaths in this group. Since April, 1970, we have undertaken emergency myocardial revascularization by saphenous vein technique on 51 patients, 48 male and 3 female patients, with an acute myocardial process manifested by chest pain lasting longer than 1 h, unrelieved by nitrate therapy and with ECG changes of acute injury. Diagnostic left heart catheterization with left ventricular (LV) angiography and selective angiography was performed on the average of 2 h from the onset of chest pain and the patient was revascularized on an average of 5 h from the onset of the chest pain. Of these 51 patients, 4 were in cardiogenic shock. One was placed on balloon assistance for several hours while the operating room was being prepared and immediately after surgery the balloon assistance was discontinued; the patient maintained a satisfactory blood pressure and made an uneventful recovery. The second patient was in profound shock and had multiple ventricular fibrillation. He was defibrillated 12 times and had an emergency temporary pacemaker implanted. This patient had a triple bypass graft performed and made a satisfactory recovery and left the hospital 10 days postoperatively. The remaining 2 patients were in cardiogenic shock. They both were operated upon after they had been in cardiogenic shock longer than 6 h. Both of these patients died.
Downloaded by: University of Cambridge 131.111.164.128 - 3/19/2019 3:45:29 PM
Thoracic and Cardiovascular Surgery, Spokane, Wash.
GANII/DuvOISIN
141
Author's address: JOHN H. GANlI, M.D., South Center Medical Building, Spokane, W A 99204 (USA)
Downloaded by: University of Cambridge 131.111.164.128 - 3/19/2019 3:45:29 PM
The mortality in this group of 51 patients is 4 %. 27 of these patients have been restudied, showing an average decrease in LV diastolic pressure from 19.6 to 14.4 mm Hg, and a graft potency rate of 93 %. This data suggests that emergency surgery done within 6 h of acute myocardial infarction may preserve some ventricular function in the face of acute myocardial process.
