Surgical myocardial revascularization (CABG) in patients with pulmonary disease: Beating heart versus cardiopulmonary bypass

Background. Adverse effects on the respiratory system can be severe in many instances after coronary artery bypass grafting (CABG) with cardiopulmonar y bypass (CPBP). Recently, operative techniques without CPBP have gained wi despread consent, thanks to the newly developed retractors that allow satis factory immobilisation of the surgical held, Methods. Thirty-seven patients operated upon in our Institution between Apr il 1997 and April 1998 showed an obstructive and/or restrictive pulmonary d isease. Twenty-one patients were operated on without CBPB (-group A), while 16 patients were operated using CPBP (-group B, control). The allocation i n each group had been randomised. Results, The length of the operation in group A was less than in group B (1 96 +/- 35 minutes vs 235 +/- 60 minutes), (p=0.014), A significant differen ce was found in postoperative bleeding: 562 +/- 381 mi vs 776 +/- 378 (p=0. 046), in postoperative red cell count, hemoglobin level and Hct Permanence on the ventilator was 19.1 +/- 13 hours in group B and 13.1 +/-6.1 hours in group A (p=0.03). The length of stay in ICU was significantly different: 3 3.8 +/- 16.2 hours for group A vs 53.6 +/- 29.3 hours for group B (p=0.01). No respiratory failure occurred in group A; two patients experienced slow weaning from ventilation assistance and one died from that complication in group B. Conclusions. Myocardial revascularization without CPBP allows a better post operative clinical course in patients with advanced pulmonary disease.