Direct Myocardial Revascularization without Extracorporeal Circulation: Experience in 700 Patients

doi:10.1378/chest.100.2.312

Chest

Volume 100, Issue 2, August 1991, Pages 312-316

https://doi.org/10.1378/chest.100.2.312 Get rights and content

Between May 1978 and March 1990, 700 patients were operated on with direct coronary surgery without extracorporeal circulation (ECC): 529 (76 percent) were male and 171 (24 percent) were female. The average age was 64 years (range, 35 to 86 years), 454 (65 percent) had unstable angina, 163 (23 percent) had stable angina, 51 (7 percent) had postmyocardial infarction angina, and 32 (5 percent) had acute myocardial infarction at the moment of the operation. In this series of patients, all branches of the coronary arteries were bypassed; the mammary artery was used in 40 percent of the cases, the average bypass per patient was 2.2 (range, 1 to 5), and 26 percent had associated disease of high risk to undergo ECC. The morbidity was 4 percent and the mortality for this series of patients was 1 percent; the probability of survival at seven years was 90 percent. This experience shows us that this surgery is an alternative in the treatment of coronary disease, especially for aged patients with associated disease, in some cases of acute transmurai infarction, and also for patients who need coronary angioplasty. Also, it can improve the relation cost/benefit in coronary surgery.

(Chest 1991; 190:312-16)

Section snippets

METHODS

From 1978 to March 1990, 1,672 patients underwent CABG at our institution. Of these, 700 underwent CABG without ECC. There were 529 (76 percent) male and 171 (24 percent) female patients. The average age was 64 years (range, 36 to 86 years). The indications for surgery included the following: unstable angina, 454 (65 percent); stable angina, 163 (23 percent); postmyocardial infarction angina, 51 (7 percent); and acute infarction, 32 (5 percent). In this series of patients, all branches of the

RESULTS

The operative mortality was eight patients (1 percent). One patient died of a massive pulmonary embolism; he had been bedridden for one month prior to surgery. The rest were from postoperative mediastinitis (five patients) and two from cardiac-related deaths. Of the 700 patients, 350 were younger than 65 years old and the mortality in this group was 0.9 percent. There were 158 patients from 65 to 70 years old with a 1.5 percent mortality, while 141 patients were from 70 to 80 years old with a

DISCUSSION

There is no doubt that the widely accepted method for coronary surgery is with the nonbeating heart. We have not noted significant differences in the analysis of postoperative angiograms (Fig 1) between the patients operated on using this technique without cardiopulmonary bypass vs those operated on with cardiopulmonary bypass using either SVG or IMAs as conduits.

We believe that the correct selection of the site for the anastomosis and the adequate use of the surgical technique are fundamental

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: Manuscript received September 24; revisiots accepted December 10.

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Chest

Clinical InvestigationsDirect Myocardial Revascularization without Extracorporeal Circulation: Experience in 700 Patients

Section snippets

METHODS

RESULTS

DISCUSSION

Ann Thorac Surg

J Thorac Cardiovasc Surg

Am Heart J

Am Heart J

Development of anastomosis between coronary vessels and transplanted mammary artery.

Med Assoc J

Survival after coronary endarterectomy in men.

JAMA

Anastomosis of a systemic artery to the coronary.

Can Med Assoc J

The coronary circulation.

John Hopkins Med J

Aortocoronary bypass with saphenous vein graft.

JAMA

Mammary artery-coronary artery anastomosis as a method of treatment for angina pectoris.

J Thorac Cardiovasc Surg

Saphenous vein autograft replacement of severe segmental coronary artery occlusion.

Ann Thorac Surg

An aggressive surgical approach to coronary disease.

J Thorac Cardiovasc Surg

Coronary vein graft without cardiopulmonary bypass a surgical motion picture.

Ann Thorac Surg

Clinical Investigations
Direct Myocardial Revascularization without Extracorporeal Circulation: Experience in 700 Patients