Initial experience with beating heart surgery: Comparison with fast-track methods

Cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG) may increase postoperative complications in high-risk patients. The goal of thi s study is to retrospectively review a series of consecutive patients under going conventional CABG using a fast-track recovery method and to compare t his series with the initial series of patients undergoing beating heart sur gery using either the single-vessel minimally invasive approach or the off- pump multivessel bypass technique with a median sternotomy. One hundred fif ty-eight consecutive patients underwent CABG. One hundred four patients und erwent conventional CABG using CPB with a short-pump fast-track recovery me thod (Group A). Twenty-nine patients underwent a single-vessel bypass via a left anterior thoracotomy off pump [Group B, minimally invasive direct cor onary artery bypass (MIDCAB)]. Twenty-five patients underwent multivessel C ABG with a median sternotomy off pump (Group C). Short-pump fast-track (Gro up A) patients exhibited minimal complications and expedient recovery and r eceived extensive revascularization. Off-pump multivessel patients (Group C ) received fewer bypass grafts, had more preoperative comorbidity, and reco vered as quickly as lower-risk fast-track short-pump patients (Group A). Si ngle-vessel off-pump patients (Group B, MIDCAB) were younger elective patie nts and demonstrated no recovery advantage. The overall mortality was 1.8 p er cent. The conversion rates from beating heart surgery to CPB for groups B and C were 10.3 and 16 per cent, respectively. The postoperative hospital length of stay for groups A, B, and C were 4.8 +/- 2.4, 3.9 +/- 1.8, and 5 .2 +/- 2.3 days, respectively. Eliminating CPB is not as important as reduc ing exposure for minimizing operative risk. Beating heart surgery is an adj unct to conventional CABG with CPB, The off-pump multivessel bypass techniq ue is best suited for high-risk patients requiring three grafts or fewer, w hereas MIDCAB is best suited for single-vessel bypass that cannot be manage d using interventional percutaneous techniques; however, the recovery advan tage with MIDCAB is not apparent. Patients requiring more than three bypass grafts should undergo conventional CABG with CPB.