Beating heart coronary artery bypass grafting: Technical aspects and results in 200 patients

OBJECTIVE: To describe the initial experience of the first 200 patients who underwent coronary artery bypass grafting (CABG) on beating hearts at the Montreal Heart Institute, Montreal. DESIGN: A prospective cohort of 200 pat ients was analyzed to study immediate and short term (two-year follow-up) r esults. SETTING: Patients underwent CABG at the Montreal Heart Institute from Febru ary 1996 to June 1998. The first 30 patients underwent CABG without the use of a myocardial wall stabilizer (group 1), and a myocardial wall stabilize r was used in the following 170 patients (group 2). PATIENTS: Group I patients averaged 60+/-10 years of age compared with 66+/ -10 years in group 2 (P=0.002). Twelve patients (40%) in group I had unstab le angina compared with 107 patients (63%) in group 2 (P=0.03). INTERVENTIONS: Group 1 patients underwent 1.7+/-0.7 CABG per patient compar ed with 2.4+/-0.8 grafts per patient in group 2 (P=0.001). Sixty seven pati ents (39%) in group 2 had an obtuse marginal coronary artery grafted, and 1 45 patients (73%) of both groups had a complete myocardial revascularizatio n. RESULTS: Ten patients (5%) in both groups were converted to cardiopulmonary bypass during surgery. Seven patients (3.5%) died postoperatively: five fr om myocardial infarction, one from aortic dissection and rupture, and one f rom arrhythmia. Seventeen patients (8.5%) suffered a perioperative myocardi al infarction. In groups 1 and 2, respectively, actuarial survival was 100% and 95+/-2%, and freedom rate from reoperation, percutaneous balloon dilat ion and recurrent myocardial infarction averaged 93+/-4% and 97+/-2% 18 mon ths following CABG. CONCLUSION: CABG on beating hearts appears to be an alternative approach to the use of cardiopulmonary bypass in selected patients.