Outcome of non-elective coronary artery bypass grafting without cardio-pulmonary bypass

Objectives: There is limited experience in the use of beating heart coronar y artery bypass grafting (CABG) in emergency and urgent cases. The aim of t his study was to retrospectively assess the safety and efficacy of this tec hnique when used in a non-elective setting. Methods: We retrospectively rev iewed all urgent and emergency cases of coronary artery bypass grafting per formed without cardiopulmonary bypass (CPB) from July 1999 to February 2000 . There were 35 patients in total. The mean age was 64.8 +/- 11.9. Twenty-s ix (74.3%) patients had Canadian Cardiovascular Society grade 4 angina. Twe nty-six patients (74.3%) had triple vessel disease. Eleven patients (31.4%) were on preoperative IV nitrates and nine patients (25.7%) had a preoperat ive IABP (intra aortic balloon pump). Three patients (8.6%) had suffered a preoperative cardiac arrest during coronary angiography. Other associated s ignificant risk factors were smoking (60%), hypertension (40%), hypercholes terolemia (57.1%) and previous Q wave myocardial infarction (31.4%). Result s: Twenty-two patients (62.9%) were classified as being urgent and 13 patie nts (37.1%) were classified as emergencies. The mean number of anastomoses performed were 2.8 +/- 0.8 (range 14) with 68.6% of patients under going tr iple or quadruple vessel grafting. All patients (100%) received at least on e arterial graft. There was no conversion to cardiopulmonary bypass. The ma in postoperative complications were - supraventricular arrhythmias eight (2 2.9%), low cardiac output seven (20%) and postoperative HF/dialysis two (5. 7%). The median postoperative intensive care unit (ICU) stay was 27.5 h. Th e mean postoperative hospital stay was 8.3 +/- 3.1 days. One patient died ( 2.9%) at the eighth day after surgery due to postoperative myocardial infar ction, multi-organ failure secondary to the septicaemia and ventricular arr est. Conclusion: Non-elective CABG without CPB is feasible and safe with mo dem cardiac stabilization devices. (C) 2001 Elsevier Science B.V. All right s reserved.