ORIGINAL ARTICLES  CARDIAC PAPERS 

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

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

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.