Multiple arterial conduits without cardiopulmonary bypass: early angiographic results.
BACKGROUND
Lack of angiographic results and technical difficulty in grafting the vessels in the lateral and posterior walls have reduced interest in myocardial revascularization without cardiopulmonary bypass (CPB). We describe our experience to demonstrate the feasibility of coronary surgical intervention without CPB in multivessel disease.


METHODS
From May 21, 1997, through February 1998, 227 patients underwent revascularization with two or more arterial conduits as the first operation: 122 without CPB (group A) and 105 with CPB (group B). Group A included a greater number of high-risk patients.


RESULTS
Mean +/- SD anastomoses per patient were 2.5 +/- 0.6 in group A and 2.8 +/- 0.8 in group B (p = NS). No patient died in group A, whereas 1 patient (0.9%) died in group B. The postoperative complication rate was low in both groups, but intensive care unit and in-hospital stays were shorter in group A than in group B (14.1 +/- 7.1 versus 27.3 +/- 36 hours, p < 0.001, and 4.1 +/- 1.6 versus 5.4 +/- 2.4 days, p < 0.001, respectively [group A versus group B]). Sixty-seven patients in Group A (54.9%) underwent postoperative angiography 33 +/- 35 days after operation. The patency rate was 98.9% (98.2% for the marginal branches).


CONCLUSIONS
Arterial revascularization of the coronary arteries without CPB is feasible, with results similar to those obtained with CPB. The two techniques, in our opinion, are complementary, not antagonistic.
Calafiore
A M
AM
Division of Cardiac Surgery, University G. D Annunzio, Chieti, Italy. calafiore@unich.it
Teodori
G
G
Di Giammarco
G
G
Vitolla
G
G
Maddestra
N
N
Paloscia
L
L
Zimarino
M
M
Mazzei
V
V
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000295:instrumentation; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D018570:Risk Assessment; D013525:Surgical Instruments