Coronary artery bypass grafting in the awake patient: three years' experience in 137 patients

Our experience with 137 patients operated on without general anesthesia is reviewed to explore the validity of our surgical strategy.

Between October 1998 and January 2002, 137 patients underwent coronary artery bypass grafting with high thoracic epidural anesthesia. There were 47 female and 90 male patients, ranging in age from 37 to 92 years (mean, 68 +/- 12 years). Two patients underwent reoperation. Nineteen patients had contraindications for general anesthesia. Target vessels involved were the left anterior descending artery in 122, the right coronary artery in 6, the left anterior descending artery plus right coronary artery in 7, and the left anterior descending artery plus circumflex artery in 2 patients. Coronary artery bypass was performed through limited access in 74 patients (H-graft in 42 and rib cage lifting in 32 patients) and through a median sternotomy in 63 patients. Cardiopulmonary bypass was not used.

In 39 (28.4%) patients pneumothorax was observed during surgical intervention. There was no mortality. Of the 137 patients, 132 (96.3%) completed the procedure awake. In 58 patients the intensive care unit was not used. Eight patients were discharged from the hospital on the day of their operation. Mean length of hospitalization was 1 day (range, 0-3 days). One hundred thirty-one patients were followed up for a period of 3 months and 3 years after their operations, and 94.7% of the patients were symptom free. Control angiograms were obtained in 41 patients. Graft patency was 100%, with one radial artery graft spasm.

Our initial experience confirms the feasibility and safety of performing coronary artery bypass grafting in the conscious patient without general anesthesia. Further study is required to define the possible extent and limitations of this strategy.