COMPARISON OF MYOCARDIAL REVASCULARIZATION WITHOUT CARDIOPULMONARY BYPASS TO STANDARD OPEN-HEART TECHNIQUE IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION

Objective: To compare myocardial revascularization without cardiopulmo nary bypass to standard open heart technique in patients with left ven tricular (LV) dysfunction. Methods: 117 patients with LV dysfunction ( ejection fraction (EF) < 35%) underwent coronary artery bypass surgery between January 1991 and July 1994. Sixty-four (group A) were operate d on without a cardiopulmonary bypass, and 53 (group B) with one. Prev alence of EF < 20% (17 vs. 6%) and emergency operations (22 vs. 7%, P = 0.03) was higher in group A. The average number of grafts was 1.9 +/ - 0.8/pt in group A and 3.5 +/- 0.9/pt in group B (P < 0.01), and the internal mammary artery was used in 54 (84%) and 42 (79%) patients, re spectively. Only 16 patients (25%) in group A received a graft to a ci rcumflex marginal artery compared to 51 (96%) in group B (P < 0.0001). Results: Two patients (3.1%) died perioperatively in group A compared to 7 (13%) in group B (P = NS). In two patients from group A (3.1%) a nd in four (7.5%) from group B intra-aortic balloon pump was inserted postoperatively (P = NS). One year actuarial survival was 91 and 79% ( P = 0.03) and 2-year survival was 86 and 65% (P = 0.04), respectively. Return of angina occurred in five (8%) and three (6%) patients (P = N S). Conclusions: These results show a trend for lower operative risk r esulting in better overall survival in selected patients with LV dysfu nction undergoing coronary artery bypass surgery without cardiopulmona ry bypass. Copyright (C) 1997 Elsevier Science B.V.