[Revascularization of the circumflex artery with mechanical stabilization: initial experience]

To evaluate the short-term result of the coronary artery revascularization without cardiopulmonary bypass for triple vessel disease, including the circumflex territory performed on the stabilized beating heart.

Prospective study conducted on the first 35 consecutive patients with triple vessel disease operated upon without cardiopulmonary bypass by a single surgeon (RC) at the Montreal Heart Institute between October 1996 and March 1997.

Mean age of patients was 64 +/-1.6 years and the majority were men (30). Most common risk factors were hypercholesterolemia (65%) and familial history (55%) of ischemic heart disease. Main surgical indication was unstable angina (74%) and mean preoperative left ventricular ejection fraction was 53 +/- 3%. Hundred and twelve bypass were constructed averaging 3.2 +/- 0.1 grafts/patients of which 39 were made on branches of the circumflex artery. Average ischemic time was 34.17 +/- 2.17 minutes. The internal thoracic artery, saphenous vein, and radial artery were used as a vascular conduit in 44, 67, and 1 occasions respectively. There was one operative mortality, and one non Q perioperative myocardial infarction (CK-MB: 89 U/L). No patient required aortic counterpulsation balloon assistance. The average postoperative CK-MB (U/L) were 12.2 +/- 1.9, 15.2 +/- 3.2, and 10.3 +/- 1.7 at 1, 24 and 48 hours respectively. During the post-operative period 26% (9) of the patients presented atrial fibrillation, 6.5% (2) early reexploration for bleeding, and 63% (22) did not require transfusion. Average stay in hospital was 6.1 +/- 45 days. Coronary grafts were angiographically assessed in the first 10 patients and at the postmortem exam in one and displayed a 100% patency with 93.5% (29/31) adequate runoff.

Triple vessel coronary artery disease revascularization is feasible on the beating heart without cardiopulmonary bypass with excellent short-term clinical and angiographic results.