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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2000 April;41(2):175-9

lingua: Inglese

Left main coronary artery stenosis: early experience with surgical revascularization without cardiopulmonary bypass

Brann S., Martineau R., Cartier R.

From the Depart­ments of Car­diac Sur­gery (S.B., R.C.) and Anes­thesia (R.M.), Mon­treal ­Heart Insti­tute Mon­treal, ­Quebec, ­Canada


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Back­ground. To deter­mine the ­safety of sur­gical revas­cu­lar­iza­tion ­without car­di­o­pul­mo­nary ­bypass (CPB) in ­left ­main ­stem (LMS) cor­o­nary sten­osis.
­Methods and ­results. ­Between ­October 1996 and ­April 1998, 67 con­sec­u­tive ­patients ­with a ≥50% LMS sten­osis under­went cor­o­nary revas­cu­lar­iza­tion ­without ­bypass (BH) and ­were com­pared to a con­tem­po­rary ­group of 160 ­patients revas­cu­lar­ized ­with con­ven­tional ­bypass (CPB). ­Mean ­ages in ­both ­groups ­were sim­ilar: 63.1 and 64.5 ­years in BH and CPB ­groups respec­tively (p=0.91). Sig­nif­i­cant ­triple ­vessel dis­ease ­occurred in 40 (80%) and 75 (47.5%) ­patients in BH and CPB ­groups respec­tively (p=NS). ­Average ­grafts per ­patient was num­bered 3.1 in BH ­group and 2.9 in CPB ­group (p=NS). The per­i­op­er­a­tive infarc­tion ­rate (­defined arbi­trarily as a CK-MB >100 U/l) was 4% (2 ­patients, ­excluding 1 pre­op­er­a­tive ­infarct) and 3.1% (5 ­patients, ­excluding 2 pre­op­er­a­tive ­infarcts) in ­groups BH and CPB respec­tively (p=0.28). Post­op­er­a­tive ­blood trans­fu­sion require­ments ­were ­less in BH ­group (19 ­patients, 38%) com­pared to CPB ­group (103 ­patients, 64.4%), (p=0.04). Post­op­er­a­tive ­inotropic require­ments ­were sim­ilar in ­both ­groups; BH ­group (15 ­patients, 30%) and CPB ­group (72 ­patients, 45%). ­Mean hos­pital ­stay was 6.4 and 7.6 ­days in BH and CPB ­groups respec­tively (p=0.49). The hos­pital mor­tality ­rate was 0% and 3.8% (6 ­patients) in BH and CPB ­groups respec­tively (p=NS).
Con­clu­sions. Our ­early expe­ri­ence sug­gests ­that non-CPB sur­gical revas­cu­lar­iza­tion in LMS sten­osis is a fea­sible and ­safe alter­na­tive to con­ven­tional car­di­o­pul­mo­nary ­bypass.

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