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Reoperative coronary artery bypass grafting without cardiopulmonary bypass
W J Fanning1, G S Kakos, T E Williams
1Division of Thoracic Surgery, Grant Medical Centers, Columbus, Ohio.
Insights
Reoperative coronary artery bypass grafting without cardiopulmonary bypass is a safe and effective procedure for selected patients. This technique offers low mortality, good graft patency, and improved long-term symptoms.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Reoperative coronary artery bypass grafting (CABG) is complex.
- Minimally invasive techniques aim to reduce morbidity and mortality.
Purpose of the Study:
- To evaluate the safety and efficacy of reoperative CABG performed without cardiopulmonary bypass.
- To assess perioperative outcomes, graft patency, and long-term functional improvement.
Main Methods:
- Retrospective analysis of 59 patients undergoing reoperative CABG without cardiopulmonary bypass between 1979 and 1992.
- Grafting strategies included left thoracotomy for circumflex artery and median sternotomy for right coronary artery and left anterior descending artery.
- Saphenous vein grafts and internal thoracic artery grafts were utilized.
Main Results:
- Overall mortality was 3.4% (2 deaths).
- Postoperative morbidity included myocardial infarction (1 patient) and pleuropulmonary complications (6 patients).
- Graft patency was 90% (18 of 20 grafts) in patients who underwent repeat angiography.
- At a mean follow-up of 42.2 months, 70% of evaluable patients were in functional class I or II.
Conclusions:
- Reoperative CABG without cardiopulmonary bypass is feasible in selected patients.
- The procedure is associated with low perioperative morbidity and mortality.
- Satisfactory graft patency and significant long-term symptomatic improvement can be achieved.
Abstract:
Between June 1979 and January 1992, 46 men and 13 women aged 35 to 81 years (mean, 58 years) underwent reoperative coronary artery bypass grafting without cardiopulmonary bypass. Isolated reoperative circumflex bypass was performed through a left thoracotomy, and reoperative bypass to the right coronary artery and left anterior descending coronary systems was through a median sternotomy. Complete revascularization was the goal in all patients. Saphenous vein grafts were placed to the right coronary artery (n = 21), circumflex artery (n = 11), and left anterior descending artery (n = 24), and 14 internal thoracic artery to left anterior descending artery bypass grafts were performed. The overall mortality rate was 3.4% (2 deaths). Postoperative morbidity included myocardial infarction in 1 patient and pleuropulmonary complications in 6. No patient was reexplored for hemorrhage, and 19 patients required no blood products. Twenty patients underwent repeat coronary angiography, and 18 of 20 grafts placed without cardiopulmonary bypass were patent. At a mean follow-up interval of 42.2 months 35 of 50 evaluable patients were in functional class I or II. In selected patients, reoperative coronary artery bypass grafting can be performed without cardiopulmonary bypass with a low perioperative morbidity and mortality rate, satisfactory graft patency rates, and good long-term symptomatic improvement.