Distal coronary artery bypass: local occlusion vs. ischemic arrest.

A retrospective study was performed on 65 patients with intractable angina and subtotal coronary occlusions undergoing aortocoronary artery bypass (ACB) to determine whether the local occlusion (L.O.) or the ischemic arrest (I.A.) technique was perferable in performing the distal coronary artery bypass. In 23 patients who had the method of local occlusion, a 45.7 percent incidence of myocardial injury was observed, compared to 42 patients undergoing ACB with ischemic arrest in whom an incidence of 22.5 percent occurred. Both serum glutamic oxaloacetic transaminase (SGOT) and creatine phosphokinase activity (CPK) determinations at 24 hours following operation in those patients not demonstrating evidence of postoperative injury were statistically higher in the local occlusion group compared to the ischemic arrest group. In the L.O. group SGOT was 155 I.U. compared to 77 I.U. in the I.A. group (p less than 0.01). CPK was 72 I.U. in the L.O. groupcompared to 34 I.U. in the I.A. group (p less than 0.05). These data suggest that, in subtotal coronary artery obstruction, the use of the L.O. technique is associated with a higher incidence of myocardial injury than is the technique of total cardiac I.A.