Multiple coronary bypass grafting: current mortality and morbidity.

Although coronary artery bypass surgery has become increasingly popular in recent years, recent critical reports have cast doubt on its efficacy in certain groups of patients. Our report reviews a recent experience with multiple coronary bypass grafting for triple vessel disease. From March 1976 to October 1978, 276 patients received from three to nine coronary bypass grafts. Combined procedures including valve replacement and ventricular aneurysmectomy are included. There were two operative deaths (30 days) for a 0.7% operative mortality. Eleven patients (4%) sustained a perioperative infarction. Other nonfatal operative complications are reviewed. The overall safety and low morbidity allow us to recommend coronary bypass surgery to certain controversial subsets of patients, ie, those with high-grade double and triple vessel disease with stable angina.

A prospective evaluation of the pulsatile assist device.

Conversion of roller pump flow to pulsatile flow by the pulsatile assist device (PAD) is said to result in improved myocardial preservation and a decrease in the incidence of perioperative myocardial infarction. The clinical advantages of the PAD were evaluated in a prospective randomized study of 100 consecutive coronary artery bypass operations. Serial electrocardiograms, creatine phosphokinase isoenzyme studies, and myocardial scans with technetium-labeled pyrophosphate failed to demonstrate any signficiant difference between patients with the PAD and those receiving nonpulsatile flow. Plasma hemoglobin levels were significantly higher in the PAD group indicating increased blood trauma. Other potential disadvantages of the PAD are discussed. Based on this study, we see few advantages of the PAD in routine coronary bypass operations.

Strut fracture in De Bakey valve. Successful reoperation and valve replacement.

Strut fracture in a De Bakey aortic valve is reported. The theoretical disadvantage of a Pyrolite carbon--coated ball and titanium struts is mentioned. Periodic cinefluoroscopy is recommended in all patients with a De Bakey aortic valve to avoid the complications associated with strut wear or fracture.

Traumatic aortorenal vein fistula: repair using total circulatory arrest.

Fistulas between the abdominal aorta and renal vein are exceedingly rare. Diagnostic delays are not unusual. Correction can be extremely difficult because of anatomical distortion and size of the arterialized veins. A young woman with such a fistula following a gunshot wound is presented. Four years following injury, the fistula was repaired successfully during intentional arrest of the circulation for 7 minutes. This was accomplished with deep hypothermia and cardiopulmonary bypass. No serious problems occurred during the operation. The patient tolerated the procedure well and has been relieved of her symptoms completely. Most patients with traumatic or spontaneous arteriovenous fistulas can be managed safely and effectively by conventional operative techniques. In selected situations, the risk of total circulatory arrest and deep hypothermia may be less than the risk of uncontrollable bleeding inherent in conventional techniques. Suggested indications for use of total circulatory arrest in vascular surgery are (1) inability to achieve vascular control by more conventional means, (2) massive distention of regional veins as occurrs in well established fistulas of the trunk, (3) one or more prior corrective attempts with use of conventional techniques, and (4) anticipated anatomical distortion and/or multiple abnormal vascular communications. This technique is a valuable approach to the correction of otherwise inoperable cardiovascular lesions.