RESUMEN
In 322 patients undergoing isolated coronary artery bypass grafting, the possible factors responsible for the development of intraventricular conduction disturbances were investigated. In 18 patients (5.6%), complete right bundle branch was observed perioperatively, 2 of whom also demonstrated left anterior hemiblock. Left bundle branch block, either complete or incomplete, was not observed. Patients demonstrating perioperative complete right bundle branch block were further characterized by the finding that 14 of 18 (77.7%) had preoperative inferior wall infarction as opposed to only 34% in the remaining 304 patients. Fifteen of the 18 patients (83.3%) had prolonged aortic cross-clamp times in contrast to only 37.5% of the remaining patients. Three-vessel disease, present in 16 of the 18 (88.9%) patients, was less frequently present (56.2%) in those in whom complete right bundle branch block did not develop perioperatively. Application of the chi 2-test showed significant differences in all of the latter variables. The perioperative onset of complete right bundle branch block may be due to several factors. The results of this study indicate that the extent of scar tissue and arteriosclerotic changes as well as the ischemic time during surgery may play a decisive role. In ten of the patients, the perioperatively-incurred complete right bundle branch block was irreversible. Postoperative angiographic studies revealed no relationship between block development and graft occlusion.
Asunto(s)
Bloqueo de Rama/etiología , Puente de Arteria Coronaria , Adulto , Anciano , Enfermedad Coronaria/cirugía , Electrocardiografía , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/etiologíaAsunto(s)
Válvula Aórtica/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas/mortalidad , Válvula Mitral/cirugía , Complicaciones Posoperatorias/cirugía , Adolescente , Adulto , Anciano , Niño , Endocarditis/complicaciones , Femenino , Paro Cardíaco Inducido , Humanos , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Complicaciones Posoperatorias/mortalidad , Riesgo , Factores de TiempoRESUMEN
A brief history of the development of coronary heart surgery is presented. Modern methods include the aorto-coronary bypass using saphenous vein graft or the thoracic internal artery, and the resection of ventricular aneurysm. The own experience with a group of 262 patients revealed a total mortality of 11,4%. Selected indication, improved surgical technique and postoperative care changed coronary surgery during the recent years into a routine method. The operative risk is characterized by the anatomical location of the occlusive artery disease as well as by the left ventricular function. But even in the group with high surgical risk the operative treatment is justified since life expectancy under conservative therapy is limited. In a group with 17 late death the main cause was due to cardiac insufficiency. In the group of survivors approximately 84% of the bypass were patent after an average period of 18 months.
Asunto(s)
Enfermedad Coronaria/cirugía , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Puente de Arteria Coronaria , Femenino , Estudios de Seguimiento , Alemania Occidental , Aneurisma Cardíaco/cirugía , Humanos , Lactante , Masculino , Persona de Mediana Edad , Factores SexualesRESUMEN
Until 1974 146 patients underwent coronary surgery in Hamburg. The total mortality rate for the first 100 postoperative days was 16,3 per cent. In the last years the mortality was reduced to 14 per cent. This group included all different selective and emergency surgical procedures for coronary disease. Due to the different degree of the coronary disease and/or of the impairment of the left ventricular function the mortality ranged between 0 per cent and 35 per cent. Some clinical parameters influencing the mortality rate are discussed.