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[Left main coronary artery stenosis and revascularization in the beating heart. Short- and long-term experience]
R Cartier1, S Brann, R Martineau
1Département de Chirurgie Cardiaque (chirurgien cardiovasculaire), Institut de Cardiologie de Montréal, Québec, Canada.
Insights
Surgical revascularization without cardiopulmonary bypass (off-pump) is a safe and feasible alternative for treating left main coronary artery stenosis. This approach demonstrated comparable outcomes to traditional bypass surgery with reduced transfusion needs and no operative mortality.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Left main stem (LMS) stenosis is a critical condition requiring revascularization.
- Conventional surgical treatment involves cardiopulmonary bypass (CPB).
- Beating heart surgery (BHS) offers a potential alternative to CPB.
Purpose of the Study:
- To evaluate the safety and efficacy of BHS for LMS stenosis.
- To compare BHS outcomes with traditional CPB techniques.
Main Methods:
- A retrospective comparison of 67 patients undergoing BHS for LMS stenosis (October 1996 - October 1998) versus 192 patients who had CPB (1996).
- Analysis of perioperative infarction rates, transfusion requirements, inotropic support, hospital stay, and operative mortality.
- Groups were matched for age, sex, and preoperative risk factors.
Main Results:
- Perioperative infarction rates were similar (2.9% BHS vs. 3.1% CPB).
- BHS group showed significantly lower postoperative transfusion requirements (38% vs. 64%, p < 0.05).
- BHS group had no operative mortality, while the CPB group had 4.7% mortality.
Conclusions:
- Non-bypass surgical revascularization (BHS) is a feasible and safe alternative for LMS stenosis.
- BHS may offer advantages in terms of reduced complications and mortality compared to CPB.
Object:
To determine the safety of surgical revascularization without cardiopulmonary bypass in left main coronary artery stenosis.
Methods:
Between October 1996 and October 1998, 67 patients with a left main stem stenosis (LMS) (> 50%) underwent revascularization on beating heart surgery (BHS) and were compared to a cohort of 192 patients with LMS disease that were operated on under cardiopulmonary bypass (CPB) during 1996.
Results:
Mean age and sex distribution and prevalence of preoperative risk factors were the same in both groups as well as the average number of grafts per patient was 3.1 +/- 0.7 and 2.9 +/- 0.7 in BHS and CPB groups respectively. Perioperative infarction rate (defined arbitrarily as a CK-MB > 100 IUL) was 2.9% in BHS group and 3.1% in CPB group. Postoperative blood transfusion requirements were less in BHS group (38%) compared to CPB group (64%), p < 0.05. Inotropic requirements postoperatively were similar in both groups. Hospital stay was shorter in BHS group (6.8 days) compared to CPB group (7.6 days) although not significant. There was no operative mortality in BHS group whereas 4.7% died postoperatively in CPB group.
Conclusion:
Our experience suggests that non-bypass surgical revascularization is a feasible and safe alternative to conventional cardiopulmonary bypass.