[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
November 1974

Ischemic Myocardial Injury With Aortic Valve Replacement and Coronary Bypass

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.

Arch Surg. 1974;109(5):652-658. doi:10.1001/archsurg.1974.01360050046011
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.

References
1.
Lewis RC, Creus AB, Shirey EK, et al:  Angina pectoris and aortic valve disease: Clinical, hemodynamic and coronary arteriographic correlation , abstracted. Am J Cardiol 26:644-645, 1971.
2.
Coleman EH, Soloff LA:  Incidence of significant coronary artery disease in rheumatic valvular heart disease . Am J Cardiol 25:401-404, 1970.Article
3.
Gardner FE, White PD:  Coronary occlusion and myocardial infarction associated with chronic rheumatic heart disease . Ann Intern Med 31:1003-1009, 1949.Article
4.
Kaufman P, Poliakoff H:  Studies of the aging heart: The pattern of rheumatic heart disease in old age . Ann Intern Med 32:889-904, 1950.Article
5.
Pfister CW, Plice SG, Dodsworth J:  The coexistence of rheumatic heart disease and myocardial infarction . Dis Chest 37:240-242, 1960.Article
6.
Muller C:  Aortic stenosis and the so-called rheumatic valvular disease in a postmortem material . Acta Med Scand 156:241-261, 1950.Article
7.
Chasnoff J, Silver A:  The coexistence of rheumatic and arteriosclerotic heart disease in patients over the age of 40 years . Am Heart J 42:809-813, 1951.Article
8.
Anderson PP, Bonchek LI, Wood JA, et al:  The safety of combined aortic valve replacement and coronary bypass grafting . Ann Thorac Surg 15:249-255, 1973.Article
9.
Oury JH, Quint RA, Angell WW, et al:  Coronary artery vein bypass grafts in patients requiring valve replacement . Surgery 72:1037-1047, 1972.
10.
Flemma RJ, Johnson WD, Lepley D, et al:  Simultaneous valve replacement and aorta to coronary saphenous vein bypass . Ann Thorac Surg 12:163-170, 1971.Article
11.
Cooley DA, Dawson JT, Hallman GL, et al:  Aortocoronary saphenous vein bypass . Ann Thorac Surg 16:380-390, 1973.Article
12.
Morriss GC, Howell JF, Crawford ES, et al:  Operability of end stage coronary artery disease . Ann Surg 175:1024-1030, 1972.Article
13.
Loop FD, Favaloro RG, Shirey EK, et al:  Surgery for combined valvular and coronary heart disease . JAMA 220:372-376, 1972.Article
14.
Hultgren HN, Shettigar R, Pfeifer JF, et al: Acute myocardial infarction during surgery for coronary artery disease. Read before the National Conference on Coronary Artery Medicine and Surgery, Houston, 1974.
15.
Hultgren HN, Miyagawa M, Buch W, et al:  Ischemic myocardial injury during cardiopulmonary bypass surgery . Am Heart J 85:167-176, 1973.Article
16.
Isom OW, Kuten NO, Falk EA, et al:  Patterns of myocardial metabolism during cardiopulmonary bypass and coronary perfusion . J Thorac Cardiovasc Surg 66:705-719, 1973.
17.
Hottenrott CE, Towers B, Kurhji HJ, et al:  The hazard of ventricular fibrillation in hypertrophied ventricles during cardiopulmonary bypass . J Thorac Cardiovasc Surg 66:742-753, 1973.
18.
Griepp RB, Stinson EB, Shumway NE:  Profound local hypothermia for myocardial protection during open heart surgery . J Thorac Cardiovasc Surg 66:731-741, 1973.
19.
Heilbrunn A, Zimmerman JM:  coronary dissection: A complication of cannulation . J Thorac Cardiovasc Surg 49:767-771, 1965.
20.
Green GE, Bernstein S, Reppert EH:  The length of the left main coronary artery . Surgery 62:1021-1024, 1967.
21.
Ramsey HW, de la Torre A, Linkart J, et al:  Complications of coronary artery perfusion . J Thorac Cardiovasc Surg 54:714-718, 1967.
22.
Silver MD, Wigle ED, Trimble AS, et al:  Iatrogenic coronary ostial stenosis . Arch Pathol 88:73-77, 1969.
×