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Left main coronary artery stenosis: early experience with surgical revascularization without cardiopulmonary bypass
S Brann1, R Martineau, R Cartier
1Department of Cardiac Surgery, Montreal Heart Institute, Quebec, Canada.
Insights
Surgical revascularization without cardiopulmonary bypass (CPB) is a safe and feasible alternative for left main stem (LMS) coronary stenosis. This approach demonstrated comparable outcomes to conventional bypass, with reduced transfusion needs.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Left main stem (LMS) coronary stenosis poses significant risks.
- Surgical revascularization is a primary treatment modality.
- The safety of avoiding cardiopulmonary bypass (CPB) in LMS stenosis requires evaluation.
Purpose of the Study:
- To determine the safety and feasibility of surgical revascularization without CPB for LMS coronary stenosis.
- To compare outcomes of non-CPB revascularization with conventional CPB techniques.
Main Methods:
- A comparative study of 67 patients undergoing revascularization without CPB (BH group) versus 160 patients with conventional CPB.
- Patient demographics, perioperative infarction rates, transfusion requirements, inotropic support, hospital stay, and mortality were analyzed.
Main Results:
- Both groups had similar mean ages and rates of triple vessel disease.
- Perioperative infarction rates (4% vs. 3.1%) and inotropic requirements were comparable.
- The non-CPB group showed significantly lower postoperative blood transfusion needs (38% vs. 64.4%) and 0% hospital mortality compared to 3.8% in the CPB group.
Conclusions:
- Non-CPB surgical revascularization for LMS stenosis is a feasible and safe alternative.
- This approach may offer benefits such as reduced transfusion requirements.
Background:
To determine the safety of surgical revascularization without cardiopulmonary bypass (CPB) in left main stem (LMS) coronary stenosis.
Methods And Results:
Between October 1996 and April 1998, 67 consecutive patients with a > or =50% LMS stenosis underwent coronary revascularization without bypass (BH) and were compared to a contemporary group of 160 patients revascularized with conventional bypass (CPB). Mean ages in both groups were similar: 63.1 and 64.5 years in BH and CPB groups respectively (p=0.91). Significant triple vessel disease occurred in 40 (80%) and 75 (47.5%) patients in BH and CPB groups respectively (p=NS). Average grafts per patient was numbered 3.1 in BH group and 2.9 in CPB group (p=NS). The perioperative infarction rate (defined arbitrarily as a CK-MB >100 U/l) was 4% (2 patients, excluding 1 preoperative infarct) and 3.1% (5 patients, excluding 2 preoperative infarcts) in groups BH and CPB respectively (p=0.28). Postoperative blood transfusion requirements were less in BH group (19 patients, 38%) compared to CPB group (103 patients, 64.4%), (p=0.04). Postoperative inotropic requirements were similar in both groups; BH group (15 patients, 30%) and CPB group (72 patients, 45%). Mean hospital stay was 6.4 and 7.6 days in BH and CPB groups respectively (p=0.49). The hospital mortality rate was 0% and 3.8% (6 patients) in BH and CPB groups respectively (p=NS).
Conclusions:
Our early experience suggests that non-CPB surgical revascularization in LMS stenosis is a feasible and safe alternative to conventional cardiopulmonary bypass.