OFF PUMP REVASCULARIZATION OF THE CIRCUMF LEX ARTERY WITH MECHANICAL STABILIZATION - INITIAL EXPERIENCE

Objectives: To evaluate the short-term results of the coronary atery r evascularization without cardiopulmonary bypass for triple vessel dise ase, including the circumflex territory, performed on the stabilized b eating heart. Methods: Prospective study conducted on the first 35 con secutive patients with triple vessel disease operated upon without car diopulmonary bypass by a single surgeon (RC) at the Montreal Heart Ins titute between October 1996 and March 1997. Results: Mean age of patie nts was 64 +/- 1.6 years and the majority were men (30). Most common r isk factors were hypercholesterolemia (65%) and familial history (55%) of ischemic heart disease. Main surgical indication was unstable angi na (74%) and mean preoperative left ventricular ejection fraction was 53 +/- 3%. Hundred and twelve bypass were constructed averaging 3.2 +/ - 0.1 grafts/patients of which 39 were made on branches of the circumf lex artery. Average ischemic time was 34.17 +/- 2.17 minutes, The inte rnal thoracic artery, saphenous vein, and radial artery were used as a vascular conduit in 44, 67, and 1 occasions respectively. There was o ne operative mortality, and one non Q perioperative myocardial infarct ion (CK-MB: 89 U/L). No patient required aortic counterpulsation ballo on assistance. The average postoperative CK-MB (U/L) were 12.2 +/- 1.9 , 15.2 + 3.2, and 10.3 +/- 1.7 at 1, 24, and 48 hours respectively. Du ring the post-operative period 26% (9) of the patients presented atria l fibrillation, 6.5% (2) early reexploration for bleeding, and 63% (22 ) did not require transfusion. Average stay in hospital was 6.1 +/- 45 days. Coronary grafts were angiographically assessed in the first 10 patients and at the postmortem exam in one and displayed a 100% patenc y with 93.5% (29/31) adequate runoff. Conclusion. Triple vessel corona ry artery disease revascularization is feasible on the beating heart w ithout cardiopulmonary bypass with excellent short-term clinical and a ngiographic results.