ELIMINATION OF CARDIOPULMONARY BYPASS - A PRIME GOAL IN REOPERATIVE CORONARY-ARTERY BYPASS-SURGERY

Objective: The purpose of this study was to evaluate morbidity and mor tality in reoperative coronary artery bypass surgery using the New Yor k State database. Methods: Patients undergoing reoperative coronary ar tery bypass between January-1995 and December 1996 were included. Pati ents were operated using cardiopulmonary bypass (CPB group, n = 184) o r without cardiopulmonary bypass (non-CPB group, n = 105) by surgeon p reference. Groups were compared for preoperative risk factors, postope rative mortality and major complications. Results: Crude mortality was lower in the non-CPB group, despite a higher expected mortality, resu lting in a risk-adjusted mortality of 1.3% versus 2.7% for the CPB gro up (NS). Of non-CPB patients, 91.4% were without complications, while only 72.1% of CPB patients (P < 0.0001) were complication-free. Major complications were significantly reduced in non-CPB patients compared to CPB patients: stroke 0% versus 3.8% (P < 0.04), cardiovascular comp lications 4.8% versus 15.8% (P < 0.005), other major complications 1.9 % versus 10.4% (P < 0.007). Postoperative IABP support was needed in 1 .9% of the non-CPB group patients and in 14.2% of the CPB group (P < 0 .0007). Conclusions: The main object of reoperative CABG is to relieve symptoms, since the survival benefit of the procedure has not been de monstrated. Performance of reoperative coronary artery bypass surgery without cardiopulmonary bypass significantly reduces morbidity. We con clude that cardiopulmonary bypass should be avoided whenever possible in reoperative coronary bypass surgery. (C) 1998 Elsevier Science B.V. All rights reserved.