Complete revascularization in coronary artery bypass grafting with and without cardiopulmonary bypass

Background. The feasibility of complete revascularization on the beating he art without cardiopulmonary bypass (CPB) as compared with the standard oper ation with CPB in elective low-risk patients with multivessel disease has n ot been clearly demonstrated in a prospective trial. Methods. Eighty selected low-risk patients were enrolled. In preoperative s tudy with coronary angiography, the decision was made whether complete reva scularization without CPB could be performed. Patients were randomly assign ed to receive CABG either with (n = 40) or without CPB (n = 40). Randomizat ion criteria were age, sex, and left ventricular ejection fraction. Complet eness of revascularization as well as short- and mid-term clinical outcome in a 13.4 +/- 6.5 month follow-up period were monitored. Results. Twenty-six of 40 (65%) patients undergoing CABG without CPB underw ent complete revascularization. In 5 of these patients (12.5%) suitable ves sels were discarded for technical reasons and 9 patients (22.5%) were switc hed to CABG with CPB owing to the deeply intramyocardial course of target v essels (n = 5) or to hemodynamic instability (n = 4). In the group of patie nts operated on with CPB, 34 of 40 patients (85%) received complete revascu larization. In 6 patients (15%) suitable vessels were discarded for technic al reasons. Mean number of bypass grafts was 3.1 +/- 0.8 with CPB and 2.6 /- 0.5 without CPB (p = 0.043). Clinical outcome and hospital stay were com parable in both groups. No patient died during the study period. No myocard ial infarction was observed. Three patients undergoing CABG without CPB und erwent successful PTCA 3 months after surgery. Conclusions. CABG without the use of CPB is effective for complete revascul arization in the majority of selected low-risk patients. Nevertheless, it h as to be stated that the rate of incomplete revascularization in this early series of CABG without CFB is higher, and compromises the basic principle of complete revascularization. (Ann Thorac Surg 2001;71:165-9) (C) 2001 by The Society of Thoracic Surgeons.