Surgery for Massive Myocardial Infarction

Emergency myocardial infarctectomy has been studied experimentally and clinically. The clinical experience describes encouraging results in two of four consecutive patients. The criteria of patient selection are described, along with a suggestion that associated perforation of the ventricular septum, as documented in three of the patients, makes the operative procedure more difficult and the results less satisfactory. Experimental myocardial infarction was studied in two groups of calves with a mortality rate of 100%. In the first group emergency resuscitation by massage and bypass produced an initial resuscitation rate of 14% but a survival rate of only 11%. In the second control group of fatal infarction, resuscitation was attempted by 45 minutes of bypass, with improvement in the resuscitation rate to only 23% and proportionate improvement in the survival rate to 18%. Emergency infarctectomy dramatically increased the initial salvage rate to 100% and improved the survival rate to 41%.