[Emergency coronary artery bypass grafting for left main coronary artery disease].

Emergency coronary artery bypass grafting (CABG) for acute coronary syndrome due to left main coronary artery (LMCA) disease still remains to be a therapeutic challenge. Seventy consecutive patients underwent CABG for LMCA disease were divided into two groups, that is 21 patients with emergency CABG (Group E) and 49 with scheduled CABG (Group S). There were four in-hospital deaths (mortality rate: 19.1%) in Group E and two (4.1%) in Group S. Three of 4 deaths in Group E had cardiogenic shock associated with acute myocardial infarction (AMI) preoperatively, and low output syndrome followed by multiple organ failure postoperatively. All of four deaths cases received intermittent cold GIK cardioplegia as an intraoperative myocardial protection. On the other hand, seven cases, received retrograde continuous warm blood cardioplegia (CWBC), including AMI with shock due to LMCA occlusion and concomitant CABG and valve replacement complicated with aortic regurgitation, all survived operations. In conclusion, retrograde CWBC may be useful as an intraoperative myocardial protection in emergency CABG for AMI with shock due to LMCA occlusion.