Perioperative myocardial protection in severe coronary artery and valvular heart diseases with impaired ventricular function.

One hundred patients with severe coronary artery disease, and impaired left ventricular function were studied. Thirteen of these required valve replacements. Eight required repair of a left ventricular aneurysm. In addition, all these patients had three or more coronary artery diseases. The patients underwent aortocoronary bypass using saphenous vein grafts. For myocardial protection, general and topical hypothermia was used during the procedure, along with perfusion of the root of the aorta, with a cardioplegic solution. Additional cardioplegic perfusion was achieved by perfusing the vein graft anastomosed to the left anterior descending coronary artery below the obstruction, or other vein grafts anastomosed to the circumflex artery or the right coronary artery (or its branches if dominant), during total aortic clamping. No mortality occurred in these patients. Only two patients developed perioperative myocardial infarction, but they recovered. The authors believe that this method can offer further myocardial protection during ischemic arrest.