CORONARY-ARTERY BYPASS-GRAFTING WITHOUT CARDIOPULMONARY BYPASS - AN ATTRACTIVE ALTERNATIVE IN HIGH-RISK PATIENTS

Objective: This study compares preoperative risk factors, estimated, o bserved, and risk adjusted mortality, and postoperative complications in patients undergoing coronary artery bypass grafting. Patients were divided in two groups depending on operative method: Group A patients had coronary artery bypass grafting using cardiopulmonary bypass. In g roup B cardiopulmonary bypass was not utilized. Patients operated on b etween January 1 1995 and August 31 1996 were compared. Group A consis ted of 1829 patients and Group B 172. Methods: Patients were selected to undergo coronary artery bypass grafting without the use of cardiopu lmonary bypass either because the surgeon felt that there were contrai ndications to-or no need for the heart-lung machine. The decision to a void the use of cardiopulmonary bypass was taken pre-operatively by th e individual surgeon. Median sternotomy, formal left thoracotomy or le ft anterior small thoracotomy were used. The data was collected and va lidated by the hospital's professional data collectors. Data-analysis was performed using the NY-state database. Results: Previous heart sur gery and extensively calcified ascending aorta were significantly more common in Group B as was estimated and observed mortality: This resul ted in identical risk-adjusted mortality of 2.8%. When reoperations we re reviewed separately risk adjusted mortality was lower in Group B (2 .1 versus 3.1%) but this difference was not statistically significant. Cardiovascular-and other-complications were higher in group A patient s. In reoperative patients this difference was significant (P = 0.05). The need for postoperative mechanical assistance was also reduced (Gr oup A: 14.9% versus Group B: 1.3% P = 0.01). Conclusion: We conclude t hat coronary artery bypass surgery can be done safely in selected pati ents without cardiopulmonary bypass. Mortality is unchanged and compli cations are less frequent. Cost and hospital utilization are decreased . The greatest benefit is observed in reoperations. (C) 1997 Elsevier Science B.V.