THE EXPERIENCE OF CORONARY ARTERY BYPASS GRAFTING (CABG) OPERATION AND PERIOPERATIVE MANAGEMENT FOR CRITICAL PATIENTS / 解放军医学杂志

ABSTRACT

The experiences of coronary artery bypass grafting (CABG ) surgery and perioperative management for critical patients are reported. Forty-five critical CAD patients aged from 41 to 78 years old with 32 male and 13 female underwent CABG.The critical conditions included coronary artery disease complicated with left ventricular dysfunction (LVEF less than 30%) in 7 patients, heart valve disease in 13, postinfarction giant LV aneurysm in 6, aged 75 years or older patients with hypertension, diabetes, and renal or severe lung dysfunction in 8, and emergent CABG because of insufficient blood supply from left coronary artery during cardiac valve replacement or ascending aortic aneurysm operation in 5. Among all the patients, pure CABG was performed in 20, and CABG with other simultaneous procedures in 25. Each of 45 patients received l to 4 bypass grafts with a mean of 2 9. During the early stage of postoperation,there were low cardiac output syndrome in 6 patients, renal failure in 3, pulmonary failure in 2, and MOSF in 1.With the application of IABP, 5 from 6 LCDS patients recovered.Three patients were complicated with renal failure, and they also recovered with the use of peritoneal or blood dialysis postoperatively. During the early stage of postoperation,two patients (4 4%) died of LCOS and MOSF, respectively. One died of arrhythmia 15 months later after operation .The experiences suggest that control of hypertension,heart rate and diabetes before operation, perfect revascularization of ischemic myocardium and effective myocardial protection during operation,prevention of LCOS and renal failure after operation could improve the results of CAD patients undergoing CABG.