Surgical myocardial revascularization without cardiopulmonary bypass

Background. Though coronary artery bypass grafting (CABG) without cardiopul monary bypass is being performed with increasing frequency, in the absence of adequate angiographic follow-up, safety, reproducibility, and efficacy o f the procedure remain doubtful. In this prospective study, we report the r esults obtained by 100% angiographic follow-up of 96 consecutive patients. Methods. A total of 96 patients (age range 33 to 76 years) underwent CABG w ithout cardiopulmonary bypass. Single vessel disease was present in 46 (47. 9%) patients, double vessel disease in 31 (32.3%), and triple vessel diseas e in 19 (19.8%) patients. All patients were operated through a standard mid sternotomy and an optimal combination of pharmacological and mechanical met hods were used to restrict cardiac movements during anastomosis. All patien ts underwent coronary angiography before discharge from the hospital. Results. A total of 160 grafts were placed (range 1 to 4 grafts per patient , average 1.7 +/- 0.3 grafts per patient). A single graft was placed in 46 patients, double grafts in 38, triple grafts in 10, and quadruple grafts in 2 patients. Various grafts included pedicled left internal mammary artery (LIMA) (n = 95), free LIMA (n = 1), right internal mammary artery (n = 14), radial artery (n = 24), right gastroepiploic artery (n = 5), and saphenous vein grafts (n = 21). Operative mortality was 1.0% (1 of 96). Two patients required reoperation for excessive bleeding. Mean hospital stay was 5.7 +/ - 1.2 days. Overall angiographic patency was 95.0% with LIMA patency of 97. 9% (93 of 95). One patient with block in midsegment of LIMA was reoperated using cardiopulmonary bypass. Follow-up ranged from 4 to 17 months (mean 8. 2 +/- 3.1 months). Two patients (one with narrowed LIMA to left anterior de scending artery anastomosis, and one with patent anastomosis) had residual angina. Conclusions. Coronary artery bypass grafting without cardiopulmonary bypass is a reproducible, effective, and safe option in selected group of patient s. A conscientious approach in patient selection and route of operation is required. (C) 2000 by The Society of Thoracic Surgeons.