Multiple arterial conduits without cardiopulmonary bypass: Early angiographic results

Background, Lack of angiographic results and technical difficulty in grafti ng the vessels in the lateral and posterior walls have reduced interest in myocardial revascularization without cardiopulmonary bypass (CPB). We descr ibe our experience to demonstrate the feasibility of coronary surgical inte rvention without CPB in multivessel disease. Methods. From May 21, 1997, through February 1998, 227 patients underwent r evascularization with two or more arterial conduits as the first operation: 122 without CPB (group A) and 105 with CPB (group B). Group A included a g reater number of high-risk patients. Results. Mean +/- SD anastomoses per patient were 2.5 +/- 0.6 in group A an d 2.8 +/- 0.8 in group B (p = NS). No patient died in group A,whereas 1 pat ient (0.9%) died in group B. The postoperative complication rate was low in both groups, but, intensive care unit and in-hospital stays were shorter i n group A than in group B (14.1 +/- 7.1 versus 27.3 +/- 36 hours, p < 0.001 , and 4.1 +/- 1.6 versus 5.4 +/- 2.4 days, p < 0.001, respectively [group A versus group BI). Sixty-seven patients in Group A (54.9%) underwent postop erative angiography 33 +/- 35 days after operation. The patency rate was 98 .9% (98.2% for the marginal branches). conclusions. Arterial revascularization of the coronary arteries without CP B is feasible, with results similar to those obtained with CPB. The two tec hniques; in our opinion, are complementary, not antagonistic. (C) 1999 by T he Society of Thoracic Surgeons.