Thorac Cardiovasc Surg 1999; 47(1): 14-18
DOI: 10.1055/s-2007-1013101
Original Cardiovascular

© Georg Thieme Verlag Stuttgart · New York

Coronary Bypass Grafting Without Cardiopulmonary Bypass - Technical Considerations, Clinical Results, and Follow-up

A. Diegeler, M. Matin, V. Falk, R. Battellini, Th. Walther, R. Autschbach, F. W. Mohr
  • University of Leipzig, Heart Center, Department of Cardiac Surgery, Leipzig, Germany
Further Information

Publication History

1998

Publication Date:
19 March 2008 (online)

Abstract

Background: Coronary bypass surgery can be performed less invasively by avoiding cardiopulmonary bypass (CPB). We present our early 'off pump' coronary bypass surgery experience in combination with a minithoracotomy or sternotomy. Methods: Between 11/1996 and 12/1997 312 patients were included in a prospective study, 223 (Group A) underwent an antero-lateral minithoracotomy (MIDCAB) and 89 (Croup B) had a full sternotomy (OPCAB). ITA harvesting and anastomosis was performed under direct Vision in all cases. Different devices for local mechanical immobilization were used to perform the anastomosis. Results: In 212 patients of group A revascularization was by a single ITA graft and in 11 patients by a double graft using the radial artery as a T graft. Conversion to sternotomy and cardiopulmonary bypass was necessary in 12 (5.3%) patients. Intraoperative myocardial infarction was observed in 5 patients (2.2%). Early-postoperative reoperation due to graft failure was necessary in 5 patients (2.2%). Mortality was 0.4% (one patient). The early postoperative graft patency rate was 97.1 % as confirmed by angiography. In group B, 25 patients had Single graft and 64 patients multiple graft revascularization. Intraoperative conversion to CPB was necessary in 10 patients (11.2%). Intraoperative myocardial infarction occurred in 1 patient (1.1 %), postoperative low Output syndrome in 2 patients (2.2%). Early postoperative reoperation due to graft failure was necessary in 1 patient (1.1 %). Mortality was 1.1 %. Angiographic control of 48 patients after 6 months confirmed a patency rate of 92.6%. Conclusion: Coronary bypass surgery without using cardiopulmonary bypass is safe to achieve good early and mid-term results. MIDCAB is a minimally invasive technique. Experienced surgeons should be ready to compete with PTCA techniques.

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