Surgical therapy of myocardial infarction

Czech version

Authors: Petr Němec; Jiří Ondrášek; Petr Fila; Helena Bedáňová; Petr Pavlík
Authors‘ workplace: Centrum kardiovaskulární a transplantační chirurgie Brno, ředitel doc. MUDr. Petr Němec, CSc.
Published in: Vnitř Lék 2014; 60(4): 331-334
Category: 60th Birthday - prof. MUDr. Petr Widimský, DrSc., FESC, FACC

Overview

Introduction:
Coronary artery bypass grafting (CABG) has been replaced by percutaneous coronary interventions in the treatment of myocardial infarction (MI) nowadays. The surgical repair is the only option for mechanical complications of MI. The aim of our study was to assess the results of surgical treatment of MI.

Patients and methods:
From January 2008 to December 2012 one thousand nine hundred fifty nine patients were operated on at Centre of cardiovascular surgery and transplantations in Brno for coronary artery disease, 103 (5.3 %) of them suffered from acute MI. The interval between MI and operations was longer than 24 hours in more than half of the patients. Nineteen patients underwent PCI before operation, 32 were in cardiogenic shock with intraaortic balloon pump in 12, twelve patients were after cardiopulmonary resuscitation and 18 were on ventilation.

Results:
CABG alone was performed in 78 patients, in 25 patients mechanical complication of MI occurred; rupture of papillary muscle with mitral regurgitation in 8, rupture of interventricular septum in 11, rupture of free wall of left ventricle in 1 and evolving aneurysm of left ventricle in 5 patients. Several serious complications occurred in the postoperative period; disturbances of heart rhythm, syndrome of low cardiac output and pulmonary complications with the necessity of prolonged ventilation being the most frequent. Fourteen patients died during hospital stay (mortality 13.4 %).

Conclusions:
Patients after acute MI create the highest-risk group for surgical treatment. The reasons comprise serious preoperative status, delayed reperfusion of ischemic area and serious hemodynamic effect of mechanical complications of MI. A lot of complications may occur during postoperative course and mortality is high. In the survivals the long term follow-up is promising.

Key words:
CABG –CAD – myocardial infarction

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