Coronary surgery of the beating heart: First year of experience in a series of 317 unselected coronary patients.

From May 1999 to May 2000, 317 unselected patients, representing 92.7% of a ll coronary artery surgery procedures, underwent open heart surgery of the beating heart by median sternotomy with the aid of a cardiac stabilising de vice. The main preoperative characteristics were: mean age = 66.1 years; men = 78 .9%; left main stem disease = 31.8%; mean left ventricular ejection fractio n = 54.1%; mean Parsonnet index = 16.9. These 317 patients were compared with a group of 303 patients who underwent coronary bypass surgery the year before by the same surgical team with car diopulmonary bypass (CPB) and cardiac standstill. Seven hundred and eighty-six distal anastomoses were carried out in the bea ting heart group (2.48 grafts per patient) compared with 2.91 in the CPB gr oup: (p < 0.001). There were 10.1% single bypass, 37.5% double bypass, 47.3 % triple bypass and 5% quadruple bypass procedures. A cardiopulmonary bypas s was required in 13 patients (4.1%). The mortality at 30 days was 3.1% versus 4.6% in the CPB group (p = NS). Th e need for blood transfusion was reduced by nearly 40% in the beating heart group (23.7% versus 39.9%, p < 0.001). The incidence of cerebrovascular co mplications was reduced from 3% in the CPB group to 0.6% in the beating hea rt group (p = 0.06). The peak postoperative troponine I levels were much lo wer in the beating heart group (2.5 versus 6.4 ng/ml, p < 0.001). The authors conclude that surgery on the beating heart is feasible in most patients. Compared with conventional surgery under CPB, there seems to be l ess requirement for blood transfusion and a tendency to reduce the cerebral risk. Nevertheless, a large prospective randomised trial is required to va lidate the potential advantages and limitations of this technique with resp ect to conventional surgery and to determine the optimal indications of sur gery on the beating heart.