REOPERATIVE CORONARY-ARTERY BYPASS WITHOUT CARDIOPULMONARY BYPASS

Background. Conventional reoperative coronary artery bypass grafting u sing cardiopulmonary bypass carries relatively high mortality and morb idity. Methods. Seventy-seven patients underwent coronary artery bypas s grafting without cardiopulmonary bypass in two centers between 1988 and 1994. Mean age was 65 +/- 8 years (mean +/- SD). Twenty-three (30% ) were operated on urgently and 7 (9%) emergently. Nine (12%) were ref erred for operation up to 2 weeks after acute myocardial infarction. F ifteen patients (19%) had an ejection fraction less than or equal to 0 .35. The mean number of grafts per patient was 1.7 (range, 1 to 3), an d the internal mammary artery was used in 66 patients (86%). Only 18 p atients (23%) received at least one graft to the circumflex artery. Ho spital stay was 7.4 +/- 6.5 days. Results. Early events included opera tive death in 4 patients (5.2%), nonfatal myocardial infarction in 3 ( 3.9%), sternal infection in 2 (2.6%), and stroke in 0 (0%). Follow-up (30 +/- 15 months) showed 11 deaths (5 cardiac, 6 noncardiac), 2 (2.8% ) nonfatal myocardial infarctions, and return of angina in 9 patients (12.8%). One- and 4-year actuarial survival rates were 90% and 69%, re spectively. Conclusions. Reoperative coronary artery bypass grafting w ithout cardiopulmonary bypass has acceptable early and midterm outcome , and should be considered a viable alternative for properly selected patients. (C) 1997 by The Society of Thoracic Surgeons.