[Surgical coronary revascularization of the beating heart].
Despite the fact that all the progress in technology, surgical technique and pathophysiological knowledge has made aortocoronary bypass surgery a safe routine procedure, there are certain clinical settings where an alternative approach seems to be advantageous. In 50 patients with age ranging from 51 to 74 years with advanced coronary heart disease and poor left ventricular (LV) function, as well as in patients with good LV function and single or double vessel disease not amenable for PTCA and in patients with acute ischemia or recent myocardial infarction, we performed coronary artery bypass grafting (CABG) without cardioplegic arrest during a short period of left ventricular unloading by means of a left ventricular assist device (LVAD). During LVAD support we administered Esmolol to decrease the heart rate and to keep the heart flaccid to facilitate easier peripheral anastomosis on a breathing heart. Preoperative ejection fraction ranged from 15 to 56%. In two patients of the acute MI-group, we continued the left ventricular mechanical support postoperatively, one of them survived. We performed on average 1,4 distal anastomoses and used in 34 cases the left internal mammary artery. All but three patients survived the procedure in stable conditions and could leave intensive care after a mean stay of 1.5 days. There were no perioperative myocardial infarctions. In our view, CABG during LVAD support without heart lung machine and cardioplegia is a safe and life saving procedure. No ischemic damage is applied to the heart and it can be recommended for cautions use in select patients.
Waldenberger
F R
FR
Universitáatsklinikum Charité, Univ. Klinik für Herzchirurgie, Berlin.
Hotz
H
H
Haisjackl
M
M
Konertz
W
W
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006353:Heart-Assist Devices; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate; D016277:Ventricular Function, Left / Q000502:physiology*