ABSTRACT
The results of intra-aortic balloon pumping in 7 patients with cardiogenic shock after cardiac surgery are reported. 2 patients were unresponsive to IABP, 4 patients showed initial stabilization of the circulation, but became IABP-dependent and died. One patient could be weaned from IABP, but died of uncontrollable cardiac arrhythmias. These results are discussed.
Subject(s)
Assisted Circulation , Heart Diseases/surgery , Postoperative Complications/therapy , Shock, Cardiogenic/therapy , Adolescent , Adult , Female , Germany, West , Heart Defects, Congenital/surgery , Heart Valve Diseases/surgery , Humans , Male , Middle Aged , Shock, Cardiogenic/mortality , Time FactorsABSTRACT
Left ventricular function in 8 patients with coronary heart disease, who died during or immediately after surgery, was compared with the corresponding data of 25 survivors. Both groups were similar in age and had about the same number of myocardial infarctions preoperatively. For LVEDP, EDV, EF and VCF critical values could be defined, which were found in none of the survivors. These values were: LVDEP approximately 20 mm Hg, EDV approximately 150 ml/m2, EF less than 30% and VCF less than 0,4 circ/s. The least prognostic significance was found for LVEDP; EDV and VCF correlated best with the surgical risk.
Subject(s)
Coronary Artery Bypass/mortality , Heart Ventricles/physiopathology , Blood Pressure , Cardiac Volume , Coronary Disease/physiopathology , Humans , Male , Middle Aged , Prognosis , Risk , Time FactorsABSTRACT
An analysis is made whether and how far the aims of coronary artery bypass surgery improvement or relief of angina, improvement of the physical working capacity, improvement of the oxygen supply of ischemic myocardium, improvement of the myocardial function, improvement of longevity, can be attained. 48 percent of 87 patients had complete subsidance of angina pectoris after operation. There was a considerable improvement in 32 percent, no change in 14 percent, and a deterioration in 6 percent. After operation, the working capacity was improved in 73 percent of our patients significantly, in some cases nearly unlimited. By a comparison between loss of complaints and bypass function (open or closed) we found a good correlation between functioning bypasses and complaints. But there are some cases without complaints in spite of a closure of the bypass. Also the reverse, unchanged complaints in spite of an open bypass, was seen. A normalisation of preoperative disturbed myocardial function can be attained. Significant improvements, but also deteriorations can be found. Generally, there is a good correlation between improved myocardial function and improvement of the working capacity. Yet there is not rarely a discrepancy between a significant improvement of the working capacity and the left ventricular function. The explanation may be a loss or a postoperative augmented threshold for anging pectoris. Comparing the groups of patients with conservative and surgical treatment, the superiority of surgical treatment cannot be proved as yet. An exception seems to be the stenosis of the left main coronary artery. With this exception, prognostic considerations cannot play a role for the indication of a coronary bypass operation. Aspects for the indication of coronary surgery are untractable or disabling angina pectoris and the consideration how impending complications can be prevented.
