Off-pump myocardial revascularization using arterial conduits without cardiopulmonary bypass.

OBJECTIVE: The feasibility of myocardial revascularization via a median sternotomy with arterial conduits, without and with cardiopulmonary bypass (CPB), was evaluated. MATERIAL AND RESULTS: From May 21, 1997, to November 30, 1999, 721 patients had myocardial revascularization without CPB via median sternotomy using at least two arterial conduits. The procedure was performed without CPB in 322 patients (Group A); the remaining 399 patients (Group B) underwent the same operation with the aid of CPB. Group A patients were older, with a higher ejection fraction and less redo than Group B. There was no early death in Group A versus nine (2.3%) patients in Group B (p < 0.02). Incidence of cerebrovascular accident (CVA) and acute myocardial infarction (AMI) were similar in both groups. Early major events incidences were 1.2% versus 8.0% (p < 0.001) in Groups A and B, respectively. Postoperative angiographic controls showed a cumulative patency rate of 98.4% and a perfect patency rate of 96.7%. After 30 months, Groups A and B showed an actuarial survival of 98.1 +/- 0.7 and 96.5 +/- 2.8 (p = ns) and an event-free survival of 96.6 +/- 1.0 and 96.5 +/- 2.8 (p = ns), respectively. CONCLUSION: Myocardial revascularization without CPB using arterial conduits can be accomplished with the same quality of results obtained with the use of CPB.

Minimally invasive coronary artery bypass grafting on a beating heart.

BACKGROUND: We reviewed our experience with left internal mammary artery (LIMA)-to-left anterior descending artery (LAD) anastomosis on a beating heart through a left anterior small thoracotomy. METHODS: This procedure was performed in 343 of 358 scheduled patients; in 15 (4.2%) the LAD was not suitable or was too small. The chest was opened in the fourth (127, 37.0%) or fifth (197, 57.4%) intercostal space, or both (19, 5.6%); the length of the harvested LIMA was 4-15 cm. The LAD was occluded by means of two 4-0 Prolene (Ethicon, Somerville, NJ) sutures, both snared on a small piece of silicone tubing. The anastomosis was performed with two 8-0 Prolene sutures. In the early postoperative period all patients underwent angiography or a doppler flow assessment of the LIMA or both. RESULTS: In 310 patients the LIMA was connected directly to the LAD; to elongate the LIMA, in 30 patients an inferior epigastric artery and in 3 patients a saphenous vein was used. In 2 patients the diagonal branch was also grafted using an inferior epigastric artery from the LIMA. Three patients (0.9%) died during the first 30 days after the operation, and 4 other patients (1.2%) died after the first month. Twenty-five patients (7.3%) were reoperated on because of anastomotic or conduit failure, 18 (5.2%) early and 7 (2.1%) late; one additional patient had a late percutaneous transluminal coronary angioplasty for anastomotic stenosis. At a mean of 9.5 +/- 5.7 months of follow-up, 336 patients (98.0%) were alive, asymptomatic with or without medical treatment, and without cardiac events. COMMENT: Left internal mammary artery-to-LAD anastomosis performed on a beating heart through a left anterior small thoracotomy is a procedure that can be performed with low risk and acceptable midterm results in selected patients.