WHEN the cardiopulmonary-bypass technic for cardiac operations began to evolve in the mid-1950's, there was wide enthusiasm for its potential benefits. It soon became apparent, however, that some operations resulted in early postoperative deaths and that most were due to some form of acute cardiac failure, usually manifested by low cardiac output. These deaths, it was assumed, happened because the patients had serious heart disease. Only recently has it been realized that death from acute cardiac failure soon after cardiac operations is usually related to new, and often extensive, perioperative (during or within 24 hours of the procedure) myocardial necrosis.
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