Myocardial Preservation in Emergency Coronary Surgery

Patients who have had acute myocardial infarction or are suffering from unstable angina are candidates for emergency coronary artery surgery. These patients run a high risk of postoperative myocardial insufficiency due to an extremely reduced ischemic tolerance of the myocardium, which is critically impaired even before the revascularization. The perioperative management and especially the intraoperative myocardial preservation of these patients should therefore prevent any additional loss of myocardial function or structure. Our method of myocardial preservation combines hypothermic cardioplegic arrest with maintenance of an oxidative myocardial metabolism. This is done by either intermittent or — if technically feasible — continous cardioplegic coronary perfusions and allows all distal and central vein anastomoses to be performed during a single period of cardiac arrest [1, 2].