CORONARY-ARTERY BYPASS-GRAFTING WITHOUT CARDIOPULMONARY BYPASS INITIAL EXPERIENCE OF 50 CASES

This study was undertaken to assess our experience with the first 50 p atients who underwent CABG without cardiopulmonary bypass. In seven pa tients left internal mammary artery to left anterior descending artery (LIMA-LAD) grafting was performed through a short left anterior thora cotomy. In 43 other patients median sternotomy was used. Primary CABG was performed in 48 patients; there were two reoperations. Eleven pati ents had unstable angina. Three patients had left ventricular ejection fraction (LVEF) equal to or lower than 25%, One patient had carcinoma of the right lung coexisting with unstable angina and underwent also right lower lobectomy. In each patient the clinical course, 12-lead EC C, transthoracic echocardiography and the serum levels of creatine kin ase (CPK), alanine aminotransferase (ALAT), aspartate aminotransferase (AspAT) were assessed. The need for inotropic or intraaortic balloon counterpulsation (IABP) support and blood transfusion was also recorde d. There were three deaths, all in the sternotomy group (6%). A patien t with systemic lupus erythemetodes (SLE) died of postoperative MI due to graft thrombosis. Another patient who was found to have porcelain aorta and had LIMA-LAD grafting its a rescue procedure died of MI with low cardiac output. The third patient with unstable angina and ejecti on fraction of 30% developed postoperative MI with ventricular arrhyth mia. One patient with LIMA-LAD graft in whom percutaneous translaminal coronary angioplasty (PTCA) had been abandoned because of coronary sp asm developed acute myocardial ischaemia 5 h postoperatively. He had a vein graft placed to LAD in cardiopulmonary bypass, his further cours e was uneventful. Six patients had IABP support. Nine patients needed inotropic support. Tell patients received blood transfusion. Twelve-le ad ECG did not show acute ischaemia or Mt, apart from the above descri bed cases, Echocardiographic check showed improved IVS contractility i n three patients and better apex motion in one case. Tn the other surv ivors the echocardiografic findings were the same as before the proced ure. ALAT and AspAT serum levels were normal In all the survivors, and the CPK levels did not exceed 200 IU/ml. One patient from the mini-th oracotomy group had recurrent angina 2 months after the procedure, His left internal mammary artery (LIMA) graft was occluded; we replaced i t with a vein graft. All 47 survivors remain asymptomatic, with the me an follow-up rime of 6 months. Coronary surgery without cardiopulmonar y bypass seems a valuable alternative for high-risk patients. (C) 1998 Elsevier Science B.V. All rights reserved.