TRIPLE CORONARY-ARTERY REVASCULARIZATION ON THE STABILIZED BEATING HEART - INITIAL EXPERIENCE

OBJECTIVE: TO decrease health costs and morbidity related to extracorp oreal circulation, surgeons have modified the coronary artery bypass ( CAB) technique so that it can be completed without the use of extra-co rporeal circulation. This study summarizes initial experience with dir ect coronary artery revascularization on the beating heart using a cor onary stabilizer. DESIGN: A case series. SETTING: The Montreal Heart I nstitute, a university-affiliated centre, specializing in the treatmen t of cardiac illnesses. PATIENTS: Ten patients underwent CAB by this t echnique. They presented with double or triple coronary artery disease with no intramyocardial, heavily calcified, diffused atheromatous cor onary vessels, or left main coronary disease. INTERVENTION: CAB grafti ng in the beating heart. The anterior wail was grafted in all patients , the inferior wall in 7 and the posterior wall in 7. MAIN OUTCOME MEA SURES: Patient survival and graft patency. RESULTS: One patient died o f multiple organ failure not related to the grafting technique itself, and 1 patient suffered a non-Q myocardial infarction. Early coronary angiography performed on 8 patients showed 100% graft patency, most wi th excellent distal runoff (21/22 grafts). CONCLUSION: In patients wit h adequate anatomy, performance of CAB without extracorporeal circulat ion can achieve excellent early results provided there is appropriate mechanical stabilization of the beating heart.