[Coronary surgery without extracorporeal circulation: 5-year experience]

Coronary surgery without extracorporeal circulation is now an accepted technique of myocardial revascularization. A progressive increase in operations has recently been observed.

We report our total experience with this technique in a consecutive series of patients operated on since 1991. This series is compared with other series of patients who underwent coronary surgery using cardiopulmonary bypass.

From December 1991 to July 1996, thirty patients underwent myocardial revascularization without cardiopulmonary bypass through median sternotomy at our institution. This group was retrospectively compared with 22 patients who received isolated coronary artery bypass grafting with cardiopulmonary bypass (excluding reoperations) during the same period of time.

There were two hospital deaths and one case of myocardial infarction during the early postoperative period which required urgent reintervention. There were two variables showing a statistically significant difference between the groups with and without cardiopulmonary bypass. Incidence of non-fatal preoperative myocardial infarction increased (53% vs 23%), whereas minor mechanical ventilation time was reported (7 +/- 5 vs 14 +/- 9 h) in the group without cardiopulmonary bypass. Follow-up (1 to 55 months after operation, mean 29 months) was completed. There were no cardiac-related deaths. No return of angina nor any new myocardial infarctions were recorded. New myocardial revascularizations were not necessary.

Myocardial revascularization without extracorporeal circulation obtained good results that were similar to conventional procedures and were cost-effective.