Surgical management of life-threatening coronary artery disease: experience in 18 consecutive patients with left main trunk or equivalent coronary artery obstruction associated with an obstructed or a nondominant right coronary artery.

Eighteen patients with obstruction of the left main trunk or equivalent coronary artery associated with an obstructed or a nondominant right coronary artery were studied. All patients had coronary artery bypass surgery because of their symptoms and coronary anatomy. Five patients had coronary artery bypass without the use of preoperative elective intra-aortic balloon counterpulsation, and 3 of these patients had cardiac arrest prior to insertion of the grafts. The other 13 patients received elective intra-aortic balloon counterpulsation prior to induction of anesthesia and cannulation. None in this second group of patients developed any hypotensive episodes or cardiac arrest, and all have done well following the bypass operation. This experience suggests that the use of elective preoperative intra-aortic balloon assist in patients who have a very critical coronary artery obstruction is indicated in view of the high incidence of cardiac arrest observed in patients who did not receive the preoperative elective intra-aortic balloon support.