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[Coronary artery bypass grafting without cardiopulmonary bypass: angiographic evaluation of a preliminary experience]
M Carrier1, J Lespérance, G Côté
1Département de chirurgie, Institut de Cardiologie de Montréal, Québec. carrier@icm.umontreal.ca
Insights
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass showed adequate coronary anastomoses in selected patients. This approach may reduce morbid events associated with traditional bypass circuits.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Vascular Anastomosis
Background:
- Coronary artery bypass grafting (CABG) without cardiopulmonary bypass is explored to mitigate complications linked to extracorporeal circulation.
- This technique aims to reduce morbidity associated with the heart-lung machine and blood pump.
Purpose of the Study:
- To quantitatively assess the quality of coronary anastomoses performed during CABG without cardiopulmonary bypass.
- To evaluate the patency and diameter of internal thoracic artery and saphenous vein grafts.
Main Methods:
- A total of 19 patients underwent CABG without cardiopulmonary bypass, utilizing median sternotomy or anterior minithoracotomy.
- Quantitative angiography was employed to analyze graft and native coronary artery diameters postoperatively.
- Internal thoracic artery and saphenous vein grafts were assessed for stenosis at anastomotic sites.
Main Results:
- Hospital stay averaged 5 days, with an average operating time of 144 minutes.
- Internal thoracic artery grafts showed varying degrees of stenosis proximally, distally, and at the anastomosis.
- One native coronary artery distal to the anastomosis occluded but was successfully treated with percutaneous angioplasty; saphenous vein grafts had minimal anastomotic stenosis.
Conclusions:
- Initial findings suggest that CABG without cardiopulmonary bypass can achieve adequate coronary anastomoses in carefully selected patients.
- This approach represents a viable alternative for specific patient populations undergoing coronary revascularization.
Background:
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass has been proposed to decrease morbid events related to the circuit and the blood pump.
Objective:
To evaluate quantitatively coronary anastomoses with CABG without cardiopulmonary bypass.
Setting:
Between February and December 1996, 19 patients underwent CABG, through a median sternotomy in 12 patients and an anterior minithoracotomy in seven patients. Twenty internal thoracic artery grafts and seven saphenous vein grafts were studied by quantitative angiography in the immediate postoperative period (4 +/- 2 days). Diameters of native coronary arteries and grafts were analyzed by computer.
Patients:
Patients averaged 57 +/- 8 years of age, with triple vessel coronary disease in three patients, double vessel disease in nine patients and single vessel disease in seven patients. Twelve patients underwent a single thoracic artery graft to the left anterior descending artery and seven patients underwent a double graft to the anterior descending and the right coronary artery.
Results:
Hospital stay averaged 5 +/- 2 days, operating time averaged 144 +/- 30 mins and ischemic occlusion of the left anterior descending coronary artery averaged 20 +/- 8 mins. Serum creatine kinase MB fraction averaged 11 +/- 7 U/L and 25 +/- 37 U/L, 1 and 24 h, respectively, after surgery. Diameter stenosis of the native coronary artery averaged 19 +/- 26% proximal to the anastomosis, 36 +/- 31% distal to the anastomosis and 27 +/- 32% at the anastomotic site of internal thoracic artery grafts. One native coronary artery distal to the anastomosis was occluded and an occluded anastomosis was reopened by percutaneous angioplasty 72 h after surgery. Saphenous vein grafted to the right coronary artery had only minimal stenosis at anastomotic sites.
Conclusion:
This initial experience with CABG without cardiopulmonary bypass suggests that adequate coronary anastomosis can be performed in selected patients.