Serum Transaminase Levels following Cross-Clamping of the Aorta in Open Heart Surgery without Coronary Artery Perfusion

Abstract

A study was carried out on 25 patients who underwent open heart surgery, with cross-clamping of the aorta but without perfusion of the coronary arteries to ascertain whether this produced any adverse effect on the myocardium. Serum enzyme levels (glutamic oxalacetic transaminase and glutamic pyruvic transaminase) were estimated on the first, third, seventh, and twenty-first postoperative days, these results being compared with two groups of controls; the first, 19 patients who had lung resection, and the second, 20 patients who underwent closed mitral valvotomy. The mean levels remained normal in the two control groups, but were markedly elevated on the first and third days after operation in the open heart patients, in whom they had returned to normal by the twenty-first day. No correlation was found between the transaminase levels and the duration of either the perfusion or the coronary occlusion. Four deaths occurred in the 25 patients, in only one of which could death be attributed to the technique. The survivors have shown no evidence of impaired myocardial function, and the technique appears effective and safe when limited to a maximum of 60 minutes of continuous aortic occlusion.