ABSTRACT
In many centers, coronary artery bypass grafting is currently considered during or soon after an acute myocardial infarction only after failed angioplasty. Emergency coronary artery bypass grafting (CABG) is associated with a higher mortality (6-12%) and an increased risk for developing perioperative myocardial infarction (21-71%) as compared to elective CABG.28,57,107 During recent years, new observations have been made on the patho physiology of ischemic and remote myocardium15,16,22 that gave the impetus for the develop ment for new operative strategies for patients with acute myocardial infarction and cardiogenic shock. These strategies include treatment of the ischemic myocardium during the initial reperfusion phase in order to reduce the damage that follows after reperfusion with normal blood at systemic pressure.6,17,22
This new concept of treating the ischemic tissue during the initial reperfusion phase is currently controversial. The attempt to control various components of the reperfusate and the conditions of reperfusion6,17,22 is based on the following observations: 1) The myocardial cell has an intact structure and function even after a prolonged period of ischemia (6 hours);14 2) immediate return of regional contractility after normal blood reperfusion in the beating work ing heart can not be achieved even after short ischemic periods;111 and 3) control of the initial reperfusion phase results in an immediate return of contractility after prolonged periods of acute coronary occlusion.6
