Triple coronary artery revascularization on the stabilized beating heart: initial experience

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Procedures
• Surgical Innovation

Background:

• Extracorporeal circulation in coronary artery bypass (CAB) surgery is associated with significant health costs and morbidity.
• Advancements in surgical techniques aim to mitigate these risks.
• Direct coronary artery revascularization on a beating heart offers a potential alternative.

Purpose of the Study:

• To evaluate the initial experience and outcomes of coronary artery bypass grafting performed without extracorporeal circulation.
• To assess the feasibility and early efficacy of direct coronary artery revascularization using a coronary stabilizer.
• To investigate patient survival and graft patency rates in this novel surgical approach.

Main Methods:

• A case series design was employed.
• Ten patients with double or triple coronary artery disease underwent coronary artery bypass grafting on the beating heart.
• Grafting procedures focused on the anterior wall in all patients, with additional grafting to the inferior and posterior walls in a subset of patients.
• Patient survival and graft patency were the primary outcome measures.

Main Results:

• One patient experienced mortality due to unrelated multiple organ failure; another suffered a non-Q myocardial infarction.
• Early coronary angiography in 8 patients demonstrated 100% graft patency.
• Excellent distal runoff was observed in 21 out of 22 grafted vessels.

Conclusions:

• Coronary artery bypass grafting without extracorporeal circulation can achieve excellent early results in patients with suitable coronary anatomy.
• The use of a coronary stabilizer is crucial for successful mechanical stabilization of the beating heart during revascularization.
• This technique holds promise for reducing complications and costs associated with traditional cardiopulmonary bypass.