Beating heart myocardial revascularization on extracorporeal circulation in patients with endstage coronary artery disease

Objectives: To evaluate in a cohort of ESCAD patients (pts) the effects of on-pump/beating-heart versus conventional CABG in terms of early and mid-te rm survival and morbidity and LV function improvement. Methods: Between January 1993 and December 2000, 78 (Group I) ESCAD pts und erwent on-pump/beating-heart surgery. Mean age in Group I was 66.2+/-6 (58- 79), NYHA and CCS class were 3.2+/-0.6 and 3.3+/-0.4 respectively, Myocardi al viability index 0.69+/-0.1 (%), LVEF (%) 24.8+/-4, LVEDP (mmHg) 28.1+/-5 .8 and LVEDD(mm) 69.5+/-6. Group II consisted in 78 ESCAD patients undergoi ng conventional CABG selected in a randomized fashion from an age, sex, and LVEF corrected group of patients. Mean age in Group II was 65.7+/-5 (57-78 ), NYHA 3.1+/-0.7. CCS 3.4+/-0.8. LVEF(%) 25+/-5, LVEDP(mmHg) 27.9+/-4.4 an d LVEDD(mm) 69.2+/-7.2. Results: Postoperatively, 5(7.7%) patients died in Group I versus 7(11.5%) patients in Group II (P >0.1). CPB time resulted to be in Group II patients (P = 0.001) and the mean distal anastomoses per patient was similar betwee n groups (P = Ns). Perioperative AMI (P = 0.039). LCOS (P = 0.002), necessi ty for ultrafiltration (P = 0.018) and bleeding> 1000 ml (P = 0.029) were s ignificantly higher in Group II. None of the Group I patients underwent sur gical revision for bleeding versus 8(10.3%) patients in Group II (P = 0.011 ). At 6 months after surgery, the LV function improved significantly in Gro up I patients, demonstrated by an increased LVEF = 27.24(%)(P = 0.001), low er LVEDP = 26.4+/-3(mmHg)(P = 0.029) and LVEDD = 67+/-4 (mm) (P = 0.004) in stead of a lower LVEDD = 66.8+/-6(mm) (P = 0.032) versus the preoperative d ata in Group [I. The actuarial survival at 1, 3 and 5 yr were 90, 82 and 71 % in Group I and 89, 83 and 74% in Group II (P = Ns). Conclusion: In ESCAD patients who may poorly tolerate cardioplegic arrest, on-pump/beating-heart CABG may be an acceptable alternative associated with lower postoperative mortality and morbidity. Such a technique offers a bet ter myocardial and renal protection associated with lower postoperative com plications due to intraoperative hypoperfusion. (C) 2001 Published by Elsev ier Science Ltd on behalf of The International Society for Cardiovascular S urgery.