CORONARY REVASCULARIZATION ON A BEATING H EART

Despite the fact that all the progress in technology, surgical techniq ue and pathophysiological knowledge has made aortocoronary bypass surg ery a safe routine procedure, there are certain clinical settings wher e an alternative approach seems to be advantageous. In 50 patients wit h age ranging from 51 to 74 years with advanced coronary heart disease and poor left ventricular (LV) function, as well as in patients with good LV function and single or double vessel disease not amenable for PTCA and in patients with acute ischemia or recent myocardial infarcti on, we performed coronary artery bypass grafting (CABG) without cardio plegic arrest during a short period of left ventricular unloading by m eans of a left ventricular assist device (LVAD). During LVAD support w e administered Esmolol(R) to decrease the heart rate and to keep the h eart flaccid to facilitate easier peripheral anastomosis on a beating heart. Preoperative ejection fraction ranged from 15 to 56%.