[Myocardial protection by coronary perfusion and specific problems of myocardial protection in combined valvular and coronary surgery].

The quality of the myocardial protection by bilateral coronary perfusion was studied in a consecutive series of 80 patients treated by isolated aortic replacements (47 cases) or multiple replacements (mitro-aortic, or mitro-aortic and tricuspid) 33 cases. Four low outputs (5 p. 100) were observed with only one death. Five post-operative necroses (6.25) were noted. The overall surgical mortality was 6.25 p. 100 (5 cases out of 80). There were two deaths in the series of the 47 single replacements and three deaths (9) in the series of multiple replacements. At the same time, the myocardial protection was studied in a consecutive series of 12 cases of valvular replacements combined with coronary shunts. In all of the cases, the shunt or shunts were carried out first, the myocardial protection was subsequently ensured by a coronary perfusion carried out by means of the shunts and directly through the coronary orifices. There were 2 deaths (16), 2 necroses (16) both responsible for deaths and no low output in the 10 survivors. Coronary perfusion very certainly ensures an excellent quality of myocardial protection if certain criteria are respected: hypothermia, moderate (28 degrees) bilateral perfusion with a mean perfusion pressure above 100 also ensuring a good flow through the sub-endocardial layer, which remains particularly sensitive to ischiemia. In cases of associated shunts, they must be carried out, first of all, in cases of tight senoses, over 60.