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Ischemic Myocardial Injury With Aortic Valve Replacement and Coronary Bypass
Stephen J. Rossiter, MD;
Herbert N. Hultgren, MD;
Jon C. Kosek, MD;
Robert D. Wuerflein, MD;
William W. Angell, MD
AMA Arch Surg. 1974;109(5):652-658.
Abstract
The incidence of ischemic myocardial injury was ascertained in 43 patients undergoing combined aortic valve replacement (AVR) and coronary artery bypass grafts (CABG) and compared with the incidence in patients with only AVR or CABG. Correlation was made with aortic cross-clamp time, cross-clamp and fibrillation time, and left ventricular biopsy. Myocardial infarction occurred in 21% (nine of 44) of AVR and CABG patients, 7% (eight of 119) of AVR patients, and 14% (16 of 112) of CABG patients. All patients with aortic cross-clamp times greater than 70 minutes or fibrillation times greater than two hours in the AVR and CABG group had myocardial injury. The hypertrophied ventricle is more susceptible to ischemic damage because of subendocardial hypoperfusion, especially in the fibrillating heart during reperfusion. Cross-clamp times greater than 70 minutes and fibrillation times greater than two hours should be avoided in AVR and CABG patients.
Author Affiliations
From the Western Heart Association Group, San Jose, Calif; divisions of cardiovascular surgery (Drs. Rossiter, Wuerflein, and Angell), cardiology (Dr. Hultgren), and pathology (Dr. Kosek), Veterans Administration Hospital, Palo Alto, Calif; and Santa Clara Valley Medical Center, San Jose, Calif.
Footnotes
Accepted for publication July 12, 1974.
Read before the 22nd scientific meeting of the International Cardiovascular Society, Chicago, June 21, 1974.
Reprint requests to Veterans Administration Hospital, 3801 Miranda Ave, Palo Alto, CA 94304 (Dr. Angell).
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