Indications for and Risks of Early Bypass Surgery in Patients with Acute Infarct

Abstract

Aortocoronary bypass surgery as the primary means of restoring orthograde coronary blood flow is indicated only in a limited number of patients. However, as an adjunct to thrombolytic therapy, there seems to be a place for early bypass surgery in order to improve the result of thrombolysis by increasing the coronary flow when there is a residual tight stenosis, and in order to prevent reinfarction due to reocclusion in patients with significant salvage of myocardium. Salvage of myocardium is assessed by serial intracoronary thallium-201 scintigraphy at the time of thrombolysis and relates well with the change of ventricular function. Since February 1980 39 patients have been operated upon within 24 h and 16 patients between day 1 and day 7 after thrombolysis. Though the haemodynamic data and the requirement of inotropic support did not reveal any statistically supported differences among the groups, there was a higher morbidity in the patients operated upon within 24 h. These patients required a longer time on the ventilator and spent a significantly longer time in the intensive care unit. Though there were major changes in the coagulation profiles, due to administration of both heparin and streptokinase among the patients operated upon early, there were only two bleeding complications, and as an average no more blood loss was observed through the chest tubes during the first 24 h postoperatively. It is concluded that bypass surgery can be done safely and effectively even early after thrombolysis without risk of haemodynamic deterioration or increased risk of bleeding.