Experience with Emergency Aortocoronary Bypass Grafts in the Presence of Acute Myocardial Infarction

Abstract

In the past 18 months 15 patients have undergone emergency aortocoronary bypass grafts using saphenous vein in the presence of acute myocardial infarction. Eight patients were in a state of cardiogenic shock, and seven patients were having severe cardiac arrhythmias, persistent hypotension, or signs of extending infarction. There were three operative deaths, all of which occurred in the cardiogenic shock group of patients. One patient died three months after operation of a cerebrovascular accident. There are 11 surviving patients. One patient presently has angina, and one patient shows signs of left heart failure. The remaining patients are well at the present time. We feel that angiography and surgery early in the course of a complicated myocardial infarct should diminish the immediate risk of death from both pump failure and cardiac rupture. Controlled prospective studies are required to elucidate the timing and indications for operation.