Document Detail


Depressed postoperative cardiac performance. Prevention by adequate myocardial protection during cardiopulmonary bypass.
MedLine Citation:
PMID:  1186289     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Depressed postoperative myocardial performance (low output syndrome) requiring inotropic drugs or balloon counterpulsation is due to subendocardial ischemic damage. Before July, 1972, we needed inotropic drugs in 30 to 52 per cent of 189 patients undergoing coronary revascularization or aortic or mitral valve replacement in whom we used ischemic arrest, profound topical hypothermia, and ventricular fibrillation. The mortality rate ranged from 10 to 17 per cent. Our experimental studies show that morbidity and death in such cases are caused by ischemic injury to the heart resulting from inadequate myocardial protection during bypass. Based on these experimental studies, we have, since July, 1972, employed the following principles clinically: (1) Maintain beating empty heart whenever possible; (2) maintain adequate coronary perfusion pressure (less than 80 mm. Hg); (3) avoid extreme hemodilution; (4) avoid ventricular fibrillation; (5) avoid prolonged hypothermic arrest, limiting ischemic periods to less than 15 minutes; (6) repay myocardial ischemic oxygen debt with total (vented) bypass; and (7) optimize DPTI/TTI (supply/demand ratio) pre- and postoperatively. These principles were followed in 189 consecutive operations, and postoperative inotropic drugs were needed in only 12. The principles were violated in 4 of the 12 patients (6 per cent), and 5 others had identifiable causes of myocardial depression; low output syndrome was unexplained in only 3 patients (1.7 per cent).
Authors:
G D Buckberg; G N Olinger; D G Mulder; J V Maloney
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  70     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1975 Dec 
Date Detail:
Created Date:  1976-01-26     Completed Date:  1976-01-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  974-94     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aortic Valve / surgery
Cardiopulmonary Bypass / adverse effects*,  methods
Coronary Disease / prevention & control*
Extracorporeal Circulation / adverse effects*
Heart Arrest, Induced / adverse effects*,  methods
Heart Valve Prosthesis
Humans
Mitral Valve / surgery
Myocardial Revascularization

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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