Two-Year Experience with Integrated Myocardial Management

Cardioprotective strategies, like cardiac operations, have evolved to the point that it is essential to understand and use various techniques to obtain the desired result of limitation of intraoperative damage during completion of a technically perfect operation that offers the best long-term benefit. In this report we present two-year experience in a consecutive series of patients in whom integrated myocardial management was undertaken. In this preliminary study, integrated myocardial management reduced patient morbidity significantly compared with crystalloid cardioplegia. Of the 214 patients operated with integrated myocardial management. 162 (75.7%) had undergone isolated CABG, 13 (6.1%) had CABG and additional procedures, and 39 (18.2%) had valve replacements. Parsonnet risk stratification scoring system was used to determine the approximate predicted mortality for each patient. Overall, 23 patients (10.7%) had 30 major complications. 19 of these patients were in the high-risk (>4) group. The median length of hospital stay was 8.6 days for the CABG patients, and 8.8 days for the valve patients. Among those with clinical scores of 0 to 4 (lower risk) in whom the predicted mortality was 1.3±1.6, 1 of 86 (1.2%) patients undergoing CABG died. For those with severity scores of >5 (higher risk) in whom the predicted mortality was 11.6±5.7, the observed mortality was 7.9% (7 of 89 patients). Overall mortality was 4.5% for the CABG patients, and 0% for the valve patients. For the entire group, predicted and observed mortality rates were 7.1±6.5, and 3.7, respectively. We conclude that, integrated myocardial management takes maximum advantage of the benefits of different methods of myocardial management by resolving their limitations and disadvantages.