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Direct coronary surgery with saphenous vein bypass without either cardiopulmonary bypass or cardiac arrest
Insights
Direct coronary artery surgery without cardiopulmonary bypass proved safe and effective in a select group of patients. This technique, performed on 30 individuals, resulted in no deaths or perioperative heart attacks.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
Background:
- Coronary artery bypass grafting (CABG) traditionally involves cardiopulmonary bypass (CPB) and cardiac arrest.
- Alternative techniques aim to reduce CPB-related complications.
Purpose of the Study:
- To evaluate the safety and efficacy of direct coronary artery surgery without CPB or cardiac arrest.
- To assess patient selection criteria and surgical outcomes for this technique.
Main Methods:
- Thirty patients underwent direct coronary artery surgery between October 1980 and April 1983.
- Patient selection criteria included vessel calibre (>1.5 mm), absence of significant plaque, and specific lesion locations (LAD, diagonal, RCA).
- Surgical procedures involved 17 simple, 11 double, and 2 triple aorto-coronary bypasses, with specific maneuvers for accessing target vessels.
Main Results:
- No deaths or perioperative myocardial infarctions were reported in the study cohort.
- The technique was applicable to approximately 7% of patients during the study period.
- Patients presented with various angina types (stable, unstable, post-MI) and some had severe concomitant diseases.
Conclusions:
- Direct coronary artery surgery without CPB is a viable option for carefully selected patients.
- The technique demonstrated excellent safety with zero mortality and morbidity.
- Potential for increased application of this technique in the future exists.
Abstract:
From October, 1980 to April, 1983, 30 patients underwent direct coronary surgery without either cardiopulmonary bypass or cardiac arrest. Patients were selected according to the site of the lesion or the condition of the vessel, i.e. generally arteries with a good calibre (more than 1.5 mm), without big plaques in the anastomotic area and lesions limited to the left anterior descending, the diagonal or the right coronary arteries, independently from the clinical condition or state of left ventricular function. Eighteen had stable angina, 10 unstable angina, 2 post-myocardial infarction angina, and 4 had a severe concomitant disease. The operations performed were: 17 simple aorto-coronary bypasses, 11 double bypasses and 2 triple bypasses. When it was necessary to revascularize the diagonal or the left anterior descending artery, the operating table was rotated to the right, a gauze pack was applied posteriorly and the arteries were sutured with 6-0 or 7-0 prolene sutures. There were no deaths and no perioperative infarctions. It should be noted that to date this technique could be used only on 7% of our patients, but we consider this percentage could be increased in the future.