COMPLEX CASES IN CARDIAC-SURGERY

Between January, 1968, and January, 1993, 790 patients underwent cardi ac operations that were either complex or performed in the presence of a life-threatening disease of other vital organs. There were 73 (9.2% ) operative deaths (d; < thirty days). A substantial number (n) of the operations (30 or more) and associated operative deaths included left ventricular (LV) aneurysmectomy or plication (LVA-P) with coronary ar tery bypass (CAB) grafts with, or, without other cardiac procedures (O CP; n=261; d=11.1%), cardiac reoperations (n=65; d=4.6%), CAB grafts p lus mitral or aortic valve replacement (n=59; d=1.7%), combined mitral and aortic valve replacement (MAVR) with, or without tricuspid valve (TV) replacement and CA-B grafts (n=52; d=7.7%), CAB grafting for an e nd-stage coronary artery disease (CAD; n=40; d=none), emergency CA-B g rafts for an acute myocardial infarction (MI) with cardiogenic shock ( n=37; d=24.3%), complex internal thoracic artery (ITA) grafting (n=30; d=none), and miscellaneous (n=43; d=2.3%). The best results were achi eved in CA-B grafts for an end-stage CAD, complex ITA grafting, CAB gr afts plus mitral or aortic valve replacement, cardiac reoperations, MA VR, and miscellaneous. This is probably related to an intensive treatm ent of congestive heart failure (CHF) before the operation, pretreatme nt with the oxygen free radical inhibitor (allopurinol), selective use of an intraaortic balloon assist (IABA) device, routine use of hemoco ncentrator (ultrafiltration, UF) during cardiopulmonary bypass (CPB) i n those with CHF, thorough myocardial protection, and a complete left- sided plus right-sided coronary revascularization.