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Coronary surgery without cardiopulmonary bypass
G Sani1, M A Mariani, F Benetti
1Istituto di Chirurgia Toracica e Cardiovascolare, Università degli Studi, Siena.
Insights
Coronary artery bypass grafting without cardiopulmonary bypass (CPB) is a promising technique. This "beating heart" surgery offers a safe alternative to traditional methods with low complication rates.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Cardiopulmonary bypass (CPB) carries inherent risks in coronary artery bypass grafting (CABG).
- Interest in off-pump CABG (OPCAB) has grown to mitigate these risks.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery bypass grafting without CPB.
- To assess the feasibility of OPCAB as an alternative to percutaneous coronary intervention and conventional CABG.
Main Methods:
- A prospective study of 58 patients undergoing OPCAB between November 1994 and May 1995.
- Procedures included median sternotomy or anterior thoracotomy, with video-assisted harvesting of the left internal mammary artery in some cases.
- Various arterial and venous grafts were utilized, including left internal mammary artery, saphenous vein, and radial artery.
Main Results:
- Low mortality rate (1.7%) and low incidence of postoperative low cardiac output syndrome (1.7%).
- Perioperative myocardial infarction occurred in 5.8% of patients.
- Absence of non-cardiac complications and arrhythmias, with short intensive care unit and hospital stays.
Conclusions:
- "Beating heart" coronary surgery (OPCAB) is a safe and promising alternative.
- OPCAB can be considered complementary to conventional CABG and an alternative to percutaneous transluminal coronary angioplasty.
Abstract:
The need to obviate the risks associated with cardiopulmonary bypass (CPB) in coronary surgery has led to an interest in coronary artery bypass grafting without CPB. From November 1994 to May 1995, 58 patients (49 males and 9 females, mean age 61.8 +/- 9.3 years, range 40-74) were selected for coronary artery bypass grafting without CPB. Three patients had left main stenosis and 6 had left ventricular dysfunction (ejection fraction < 40%). Stable angina was present in 42 patients (27 with low threshold angina) and unstable angina in 16. In 44 patients a routine median sternotomy and in 14 cases a small anterior thoracotomy were performed: in the latter the proximal harvesting of the left internal mammary artery was video-assisted by thoracoscopy. The left internal mammary artery was used in 53 cases; the saphenous vein was used in 36 cases; the radial artery was used in 4 cases; the inferior epigastric artery was used in 2 cases and the right gastroepiploic artery in 1 case. We recorded 1 death (1.7%) and 1 case of postoperative low cardiac output syndrome requiring counterpulsation (1.7%). Perioperative myocardial infarction occurred in 3 cases (5.8%). We did not record noncardiac complications (cerebrovascular, renal failure, prolonged ventilatory support over 24 hours or sternal wound complications). Supraventricular and ventricular arrhythmias were never detected. Mean intensive care unit and hospital stay were 1.1 +/- 0.5 and 5.1 +/- 1.7 days, respectively. In conclusion, according to our experience, "beating heart" coronary surgery is a new promising technique that can be considered alternative in most cases to percutaneous transluminal coronary angio and complementary to conventional coronary surgery.