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PubMed · 302504

[Technical problems in coronary bypass surgery (author's transl)].

R W Hacker
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Abstract

The problem of selecting the most suitable operative technique for coronary bypass surgery is demonstrated by a comparison of the most current methods. The fact, that comparable results can be obtained by various technical modifications makes it appear reasonable to choose an method as simple as possible for routine. Therefore, the following procedure is recommended: Extra-corporeal circulation with hemodilution and systemic as well as local hypothermia. Distal anastomoses under ischemic cardiac arrest without vent. Proximal anastomoses under partial extra-corporeal circulation with the heart beating. Continuous suture technique for all anastomoses. Our own clinical results with 1,3% early mortality, 1% perioperative myocardial infarctions and 94% graft patency after 1 month prove the feasibility of this operative procedure.

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Blood VolumeCoronary Artery BypassExtracorporeal CirculationHeart Arrest, InducedHumansHypothermia, InducedPostoperative ComplicationsEnglish AbstractJournal Article

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R W Hacker. 1977. [Technical problems in coronary bypass surgery (author's transl)].. https://doi.org/10.1055/s-0028-1096709

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We report a patient with nondiabetic end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD) associated with chronic hypovolemia. Despite the administration of nilvadipine, the patient showed accelerated hypertension and concomitantly orthostatic hypotension. Plasma renin activity was markedly high, and blockade of angiotensin II action by captopril or an angiotension II antagonist decreased the supine blood pressure. This indicated that the enhanced activity of the renin-angiotensin system was the principal cause of the supine hypertension. The plasma concentration of norepinephrine was also very high. After correction of hypovolemia by blood transfusion, the enhancement of the renin-angiotensin system and high plasma norepinephrine level were reduced, and symptomatic orthostatic hypotension disappeared. The accelerated hypertension was easily controlled by the administration of low-dose captopril and nilvadipine. These findings suggest that chronic hypovolemia related to the intractable supine hypertension as well as orthostatic hypotension. Hypovolemia-induced enhancement of the renin-angiotensin system and sympathetic nerve activity may cause vasoconstrictive hypertension in patients on CAPD.

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