Chest
Clinical InvestigationsDirect Myocardial Revascularization without Extracorporeal Circulation: Experience in 700 Patients
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
REFERENCES (26)
- et al.
Results of coronary bypass in elderly women.
Ann Thorac Surg
(1986) - et al.
Coronary revascularization in septuagenarians.
J Thorac Cardiovasc Surg
(1983) - et al.
Analysis of morbidity and mortality in patients 70 years or older and over undergoing isolated coronary artery bypass surgery.
Am Heart J
(1985) - et al.
Preservation of interventricular septal function in patient having coronary artery bypass grafts without cardiopulmonary bypass.
Am Heart J
(1984) Development of anastomosis between coronary vessels and transplanted mammary artery.
Med Assoc J
(1954)- et al.
Survival after coronary endarterectomy in men.
JAMA
(1957) - et al.
Anastomosis of a systemic artery to the coronary.
Can Med Assoc J
(1954) The coronary circulation.
John Hopkins Med J
(1974)- et al.
Aortocoronary bypass with saphenous vein graft.
JAMA
(1973) Mammary artery-coronary artery anastomosis as a method of treatment for angina pectoris.
J Thorac Cardiovasc Surg
(1967)
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
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Manuscript received September 24; revisiots accepted December 10.