Coronary artery bypass grafting with cardiopulmonary bypass is safe and contributes to favorable long-term results

The aim of this study was to determine the indication for minimally invasiv e direct coronary artery surgery based on the operative and long-term resul ts of conventional coronary artery bypass grafting with cardiopulmonary byp ass. Operative results: The subjects included 505 patients who underwent is olated elective coronary artery bypass grafting with cardiopulmonary bypass from January 1995 through August 1999. The mean age at the time of surgery was 61.9 and the mean number of grafts per patient was 2.6. Long-term resu lts: From January 1984 to December 1995, a total of 907 patients received c oronary artery bypass grafting with cardiopulmonary bq pass using the inter nal thoracic artery to the left anterior descending artery with or without saphenous vein grafts to other coronary arteries, The rates of complete and incomplete revascularization were 69.3% (n = 629) and 30.7% (n = 278), res pectively. Mean follow-up was 5.95 +/- 3.0 years. The operative results rev ealed low output syndrome occurred in 14 patients (2.8%), perioperative myo cardial infarction with the appearance of new Q-waves in 5 (1.0%) renal fai lure requiring transient dialysis in 16 (3.2%), stroke with persistent sequ elae in 5 (1.0%), and mediastinitis in 5 (1.0%). Two patients (0.4%) died i n the hospital. The long-term results for the 907 patients revealed the 10- year actuarial survival, 10-year cardiac death free, and 10-year cardiac ev ent free rates were 85.7%, 94.1%, and 77.3%, respectively. The 10-year surv ival rates was 88.4% among patients receiving complete revascularization an d 79.3% among those receiving incomplete revascularization (p = 0.0334). Th e 10-year cardiac death free rate among patients undergoing complete revasc ularization was 96.3% and 88.7% among those receiving incomplete revascular ization (p = 0.0016). The 10-year cardiac event free rates were 82.3% and 6 7.9% among patients undergoing complete and incomplete revascularization, r espectively (p = 0.0118). In view of the favorable operative and long-term results of conventional coronary artery bypass grafting, especially complet e revascularization, we conclude that minimally invasive direct coronary ar tery grafting is an appropriate treatment for multi-vessel disease in caref ully selected patients at a high risk for stroke and major comorbidities du e to old age.