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Forty-three patients operated on under conditions of aortocoronary bypass were examined. In 29 of them continuous circulation of cold solution in pericardial cavity was combined with antegrade cardioplegia. In 14 routine technique of external myocardial cooling with snow and antegrade crystalloid cardioplegia was employed. Intensive external cooling of the heard helped not only maintain a lower myocardial temperature but permitted also a reduction of temperature gradients between various myocardial sites. This was conducive to a better preservation of energy reserve and contractility of the myocardium.

In 21 patients with coronary heart disease, a procedure of protecting the myocardium was used during cardiac surgeries via irrigation of the pericardial cavity with circulating cold solution in combination with cardioplegia into the aortic root. The application of the procedure maintained stable myocardial temperature from 10.26 +/- 1.55 to 11.99 +/- 1.95 degrees C, excluding excessive overcooling and premature warming. The procedure awaits further studies in terms of biochemical changes and morphology of the myocardium at various stages of surgery.

With growth of the number of primary operations and duration of the postoperative period, there was an obvious tendency towards an increase of the absolute number of patients with recurrent angina pectoris. Among 990 patients who were operated on successively during a period of 9 years, 9% had severe Functional Class III-IV angina pectoris, in whom coronary bypass graphy was indicated to determine the possibility of undertaking a reoperation. The examination was conducted in 61 patients with recurrent marked angina pectoris. Impaired patency of the aortocoronary shunts was found to be the main cause of recurrence. At present, reoperations were carried out in 18 patients, 2 years after the first operation, on the average. The authors claim the immediate results of the reoperations to be satisfactory. The hospital mortality was 5.6%.

From the results of intraoperative examination of 50 patients with ischemic heart disease it is shown that the collateral blood flow has an essential effect on the detection of the signs of myocardial ischemia. Aortocoronary shunting leads to positive dynamics of regional myocardial function. The test with compression of the shunt may be used for indirect appraisal of the efficacy of myocardial revascularization.