[Coronary artery bypass grafting without cardiopulmonary bypass: angiographic evaluation of a preliminary experience].
BACKGROUND
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass has been proposed to decrease morbid events related to the circuit and the blood pump.


OBJECTIVE
To evaluate quantitatively coronary anastomoses with CABG without cardiopulmonary bypass.


METHODS
Between February and December 1996, 19 patients underwent CABG, through a median sternotomy in 12 patients and an anterior minithoracotomy in seven patients. Twenty internal thoracic artery grafts and seven saphenous vein grafts were studied by quantitative angiography in the immediate postoperative period (4 +/- 2 days). Diameters of native coronary arteries and grafts were analyzed by computer.


METHODS
Patients averaged 57 +/- 8 years of age, with triple vessel coronary disease in three patients, double vessel disease in nine patients and single vessel disease in seven patients. Twelve patients underwent a single thoracic artery graft to the left anterior descending artery and seven patients underwent a double graft to the anterior descending and the right coronary artery.


RESULTS
Hospital stay averaged 5 +/- 2 days, operating time averaged 144 +/- 30 mins and ischemic occlusion of the left anterior descending coronary artery averaged 20 +/- 8 mins. Serum creatine kinase MB fraction averaged 11 +/- 7 U/L and 25 +/- 37 U/L, 1 and 24 h, respectively, after surgery. Diameter stenosis of the native coronary artery averaged 19 +/- 26% proximal to the anastomosis, 36 +/- 31% distal to the anastomosis and 27 +/- 32% at the anastomotic site of internal thoracic artery grafts. One native coronary artery distal to the anastomosis was occluded and an occluded anastomosis was reopened by percutaneous angioplasty 72 h after surgery. Saphenous vein grafted to the right coronary artery had only minimal stenosis at anastomotic sites.


CONCLUSIONS
This initial experience with CABG without cardiopulmonary bypass suggests that adequate coronary anastomosis can be performed in selected patients.
Carrier
M
M
Département de chirurgie, Institut de Cardiologie de Montréal, Québec. carrier@icm.umontreal.ca
Lespérance
J
J
Côté
G
G
Pellerin
M
M
Searle
N
N
Pelletier
L C
LC
D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D008875:Middle Aged; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation; D016896:Treatment Outcome