CORONARY OPERATIONS IN PATIENTS WITH SPINAL-CORD INJURY

Background. The risk of heart disease in patients with spinal cord inj ury is similar to that in the general population. The physiologic dera ngements raise special problems in patients with SCI having coronary o perations. Methods. From January 1980 to May 1995, we performed corona ry artery bypass procedures on 20 patients with SCI; 4 were tetraplegi c and the remainder were paraplegic. The indication for operation was angina: unstable (13), exertional (4), or postinfarctional (3). Bowel and bladder care was given immediately before operation; operating roo m tables were double padded and a pelvic wrap was used to protect the back. Electric wheelchairs were used for early mobilization. Results. Vasomotor instability from cardiopulmonary bypass was not present in p atients with SCI. Pharmacologic support was required in the operating room by 4 patients for low vascular resistance, but in only one case i n the intensive care unit. One patient required ventilatory support fo r more than 24 hours. All patients were able to cough effectively. No thoracic wound complications occurred. There were three operative deat hs, all in patients with multiple risk factors. The acute hospital sta y averaged 9.3 days; patients were then transferred to an SCI unit for rehabilitation, where upper-extremity weight bearing was restricted f or 2 to 4 weeks. Conclusions. Patients should not be denied coronary a rtery bypass procedures because of an SCI, but their special needs mus t be managed properly.