CORONARY-ARTERY REVASCULARIZATION WITHOUT EXTRACORPOREAL-CIRCULATION - INDICATIONS AND RESULTS

Objective: Coronary artery revascularisation without extracorporeal ci rculation is a technique which can be performed in selected patients i n need of a coronary artery bypass graft. Methods: Consecutive patient s (210) underwent coronary artery bypass graft without extracorporeal circulation. Indications were high risk patients, or single coronary a rtery lesion. To predict perioperative mortality, preoperative risk fa ctors were reviewed, and Parsonnet score was calculated. Results: Ther e were seven deaths (3.3%), and univariate analysis revealed greater a ge, NYHA, and poor ejection fraction to be the only predictors of earl y mortality. Perioperative myocardial infarction included 15 patients (7.1%), most of them seen in the multiple bypass group (10/39, 26%). P atients were divided into low risk (Parsonnet score < 15) 155 patients with two deaths (1.2%), and high risk (Parsonnet score > 15) 55 patie nts with five deaths (9%). Complete revascularisation was performed in the low risk group, while in the high risk only the symptomatic vesse l was bypassed and other angiographic lesions treated with postoperati ve angioplasty (10 patients). A total of 12 patients developed early p ostoperative angina (5.7%), 9 presented an anastomosis dysfunction whi ch was treated by angioplasty (5) and surgery (4), and 188 patients (8 5.7%) did not receive transfusions while 190 patients (90.4%) did not need postoperative inotropes. Length of stay, operating room time, and medical costs were all significantly reduced. Conclusions: Myocardial revascularisation without extracorporeal circulation can be performed with a low operative mortality, and minimal morbidity only in patient s undergoing single bypass revascularisation. It can also be performed as part of a multiple revascularisation strategy in association with angioplasty in high risks patients. (C) 1997 Elsevier Science B.V.