Emergency Coronary Artery Bypass Operation for Cardiogenic Shock.
- Author:
Eung Joong KIM
1
;
Weon Yong LEE
;
Hyun Keun CHEE
;
Goang Min CHOI
;
Hyoung Soo KIM
;
Kun Il KIM
;
Hyoung Kyun MOK
Author Information
1. Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University, Korea.
- Publication Type:Original Article
- Keywords:
myocardial infarction;
angioplasty, transluminal percutaneous;
shock;
coronary artery bypass
- MeSH:
Angioplasty;
Cardiac Output, Low;
Constriction, Pathologic;
Coronary Artery Bypass*;
Coronary Vessels*;
Critical Illness;
Emergencies*;
Female;
Hemorrhage;
Humans;
Infarction;
Ischemia;
Lower Extremity;
Male;
Mortality;
Myocardial Infarction;
Operating Rooms;
Saphenous Vein;
Shock;
Shock, Cardiogenic*;
Tachycardia, Ventricular
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
1997;30(10):966-972
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Between June 1994 to August 1996, 13 patients underwent emergency coronary artery bypass operations. There were 3 males and 10 females and ages ranged from 56 to 80 years with the mean of 65.5 years. The indications for emergency operations were cardiogenic shock in 12 cases and intractable polymorphic VT(ventricular tachycardia) in 1 case. The causes of cardiogenic shock were acute evolving infarction in 6 cases, PTCA failure in 4 cases, acute myocardial infarction in 1 case, and post-AMI VSR(ventricular septal rupture) in 1 case. Five out of 13 patients could go to operating room within 2 hours. However, the operations were delayed from 3 to 10 hours in 8 patients due to non-medical causes. In 12 patients, 37 distal anastomoses were constructed with only 3 LITA's(left internal thoracic arteries) and 34 saphenous veins. In a patient with post-AMI VSR, VSR repair was added. In a patient with intractable VT and critical stenosis limited to left main coronary artery, left main coronary angioplasty was performed. Five patients died after operation with the operative mortality of 38.5%. Three patients died in the operating room due to LV pump failure, one patient died due to intractable ventricular tachycardia on postoperative second day, and one patient died on postoperative 7th day due to multi-organ failure with complications of mediastinal bleeding, low cardiac output syndrome, ARF, and lower extremity ischemia due to IABP. In 8 survived patients, 3 major complications (mediastinitis, PMI, UGI bleeding) developed but eventually recovered. We think that the aggressive approach to critically ill patients will salvage some of such patients and the most important factor for patient salvage is early surgical intervention before irreversible damage occurs.
