CORONARY-ARTERY BYPASS WITHOUT CARDIOPULMONARY BYPASS - ANALYSIS OF SHORT-TERM AND MIDTERM OUTCOME IN 220 PATIENTS

Two hundred twenty patients, preferentially those with high-risk condi tions, underwent coronary artery bypass grafting without cardiopulmona ry bypass. Early unfavorable outcome events included operative mortali ty (7 patients, 3.2%), nonfatal perioperative myocardial infarction (6 patients, 2.7%), cerebrovascular accident (1 patient, 0.4%), and ster nal infection (3 patients, 1.4%). There were two deaths (13%) among 15 patients with calcified aorta and four (12%) in 33 patients who under went emergency operation. Multivariate analysis revealed these two ris k factors to be the only predictors of early mortality (odds ratios, 8 .0 and 9.8, respectively). Preoperative risk factors such as left vent ricular dysfunction (ejection fraction less than or equal to 35%) (40 patients, 18%), congestive heart failure (46 patients, 21%), acute myo cardial infarction (59 patients, 27%), cardiogenic shock (7 patients, 3%), age 70 years or older (59 patients, 27%), renal failure (19 patie nts, 9%), and cerebrovascular accident and carotid disease (11 patient s, 5%) were not found to be major predictors of early mortality or unf avorable outcome. During 12 months of follow-up (range 1 to 21 months) , there were four cardiac and three noncardiac deaths (1-year actuaria l survival 93%) and 17 cases (7.7%) of early return of angina. Calcifi ed aorta, nonuse of the internal mammary artery, reoperation, and diab etes mellitus were independent predictors of unfavorable events. We co nclude that coronary artery bypass grafting without cardiopulmonary by pass can be done with relatively low operative mortality, although the re seems to be an increased risk for early return of angina. This proc edure should therefore be considered for patients with appropriate cor onary anatomy, in whom cardiopulmonary bypass poses a high risk. This procedure is still hazardous with calcified aorta or emergency operati on.