PRIMARY CORONARY-ARTERY BYPASS-GRAFTING WITHOUT CARDIOPULMONARY BYPASS IN IMPAIRED LEFT-VENTRICULAR FUNCTION

Background. Conventional coronary artery bypass grafting using cardiop ulmonary bypass carries relatively high mortality and morbidity for pa tients with left ventricular dysfunction. Methods. Seventy-five patien ts with ejection fraction less than or equal to 0.35 underwent primary coronary artery bypass grafting without cardiopulmonary bypass betwee n December 1991 and December 1994. Thirty-two patients (43%) had conge stive heart failure, 11 (15%) were referred far operation within the f irst 24 hours of evolving myocardial infarction, and 21 (28%) up to 1 week after acute myocardial infarction. Eighteen patients (24%), 6 of whom were in cardiogenic shock, underwent emergency operations. Result s. Mean number of grafts/patient was 1.9 (range, 1 to 4), and internal mammary artery was used in 66 patients (85%). Only 17 patients (23%) received a graft to a circumflex marginal artery. Two patients (2.7%) died perioperatively, and 1 (1.3%) sustained stroke. At mean follow-up of 28 months, 13 patients had died, and angina had returned in 7 (10. 5%). One- and four-year actuarial survival was 96% and 73%, respective ly. Conclusions. Coronary artery bypass grafting without cardiopulmona ry bypass is a viable alternative to conventional coronary artery bypa ss grafting particularly for patients with extreme left ventricular dy sfunction or those with coexisting risk factors, such as acute myocard ial infarction and cardiogenic shock. (C) 1997 by The Society of Thora cic Surgeons.